Abstract

We evaluated the agreement between wedgedhepatic vein pressure (WHVP), portal vein pressure(PVP), and its relationship with portal hemodynamics in21 patients with HCVrelated cirrhosis with esophageal varices. Direct measurements of theportohepatic gradient (HVPG) were obtained byultrasound-guided fine needle puncture of the righthepatic and the portal veins. In five cases PVP was6.4-10.4 mm Hg higher than WHVP. In 12 cases measurements weresimilar (WHVP-PVP ≤ 3 mm Hg). In the remaining fourcases WHVP was 3.6-9.6 mm Hg higher than PVP. WHVP andPVP agreement was not related to HVPG mean value,Child-Pugh score, or grading of esophageal varices. Bycontrast, the difference between WHVP and PVP wasinversely related to the portal flow velocity (P =0.053) and directly related to the portal vascularresistance (P = 0.02). Whereas the portal branches werevisualized in patients with WHVP lower or similar toPVP, a predominant left portosystemic collateral flowwas observed in patients with WHVP > PVP. Our data point out that, in patients with cirrhosis dueto hepatitis C virus infection, discrepant HVPG valuesreflect true hemodynamic differences.

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