Table 1 Cases studied

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2 Fig. 1 Intra-operative measurements using the ultrasonic Doppler duplex sys temin a patient with idiopathic portal hypertension. The shunt blood flow was measured at the splenic hilus just after the shunt procedure. The B-mode image is on the left and the Doppler spectrum is on the right. (55)

3 Table 1 Cases studied IMCS: interposition meso-caval shunt DSRS: distal spleno-renal shunt GCS: gastro-caval shunt Fig. 2 Changes in portal blood flow before and during surgery. Left: portal vein trunk, middle: splenic vein, right: superior mesenteric vein. (56)

4 Fig. 3 Changes in portal blood flow before and after surgery. IMCS: interposition mesocaval shunt, DSRS: distal splenorenal shunt, GCS: gastrocaval shunt. Fig. 5 Changes in shunt blood flow during and after surgery. Fig. 4 Changes in cross-sectional area of the portal vein bofore and after surgery. Fig. 6 Changes in portal venous pressure before, during, and after surgery. During surgery, the pressure was measured before and after each procedure. (57)

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6 2) Moriyasu F, et al: Quantitative measurement of portal blood flow in patients with chronic liver disease using an ultrasonic duplex system consisting of a pulsed doppler flowmeter and B modeelectroscanner. Gastroenterologia Japonica 19: 529, ) Reiner DS, et al: Comparative evaluation of selective and nonselective peripheral portosys temicshunts for treatment of variceal hemorr hage.am J Surg 144: 704, ) Rikkers LF, et al: A randomized, controlled trial of the distal splenorenal shunt. Ann Surg 188: 271, ) Henderson JM, et al: Current status of the distal splenorenal shunt. Seminar in Liver Disease 3: 251, ) Burchell AR, et al: Hepatic artery flow improvement after portacaval shunt: A single hemodynamic clinical correlate. Ann Surg 184: 289, ) Drapanas T, et al: Hemodynamics of the inter positionmesocaval shunt. Ann Surg 181: 523, ) Widrich WC, et al: Long-term followup of

7 distal splenorenal shunts: Evaluation by arter iography,shuntography, transphepatic portal venography and cinefluorography. Radiology 134: 341, ) Tylen U, et al: Hemodynamic changes after distal splenorenal shunt studied by sequential angiography. Radiology 121: 585, ) Mathie RT, et al: Hepatic tissue perfusion studies during distal splenorenal shunt. Am J Surg 140: 384, ) Reiche FA, et al: Hemodynamic patterns in human hepatic cirrhosis: A prospective ran domizedstudy of the hemodynamic sequelae of distal splenorenal (Warren) and mesocaval shunts. Ann Surg 137: 13, ) Rypins EB, et al: Radionuclide angiography of the liver and spleen. Am J Surg 142: 574, ) Bolondi L, et al: Ultrasonographic study of portal venous system in portal hypertension and after portosystemic shunt operations. Sur gery95: 261, ) Berger LA, et al: The ultrasonic demonstra tionof portacaval shunts. Br J Surg 66: 166, ) Inokuchi K, et al: Exclusion of nonisolated splenic vein in distal splenorenal shunt for prevention of portal malcirculation. 200: 711, 1984 Ann Surg 18) Giltin N, et al: Splenic blood flow and resis tancein patients with cirrhosis before and after portacaval anastomoses. Gastroenterology 59: 208, ) Shatney CH, et al: Effects of portasystemic shunting on visceral and portal blood flow in the dog. Gastroenterology 83: 1170, ) Barnes RW, et al: Intraoperative assessment of arterial reconstruction by doppler ultrasound. Surg Gyencol Obstet 146: 896, ) Sigel B, et al: The application of real-time ultrasound imaging during surgical procedures. Surg Gyencol Obstet 157: 33, 1983 CHANGES IN PORTAL HEMODYNAMICS AFTER PORTOSYSTEMIC SHUNT SURGERY Intraoperative and Follow-up Study Using Doppler Ultrasound Fuminori MORIYASU, Osamu NISHIDA, Nobuyuki BAN, Takefumi NAKAMURA1), Yasunari SOH2), Kensuke MIURA, Masahiko SAKAI1), Takeo MIYAKE2), Haruto UCHINO1), Keiichiro MORI, Kaoru KUMADA and Kazue OZAWA3) 1) The First Department of Internal Medicine, Faculty of Medicine, Kyoto University, Kyoto 606, Japan 2) The Department of Geriatrics, Faculty of Medicine, Kyoto University, Kyoto 606, Japan 3) The Second Department of Surgery, Faculty of Medicine, Kyoto University, Kyoto 606, Japan Changes in portal hemodynamics after porto-systemic shunt surgery were studied in ten patients with portal hypertension. Interposition mesocaval shunting (IMCS) was performed on three patients, distal splenorenal shunting (DSRS) on three patients, gastro-caval shunting (Inokuchi) on one patient, and splenectomy on three patients. Portal blood flow was measured before, after, and during surgery using an ultrasonic Doppler duplex system. Portal venous pressure was measured using percutaneous transhepatic portal catheterization before and after the surgery. The portal blood flow, and especially the splenic venous blood flow decreased during surgery compared with the preoperative value. The blood flow through the IMCS was larger than that through the DSRS, and increased after the surgery. Portal venous pressure during the surgery was higher than the pre-operative value while the pressure was decreased in the patients with shunt surgery. (60)