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Use of hepatic vein catheterization in the evaluation of patients with anasarca
J M Insel1, S Mookherjee, H Smulyan
1Department of Medicine, Cardiology Section, Veterans Administration Medical Center, Syracuse, New York.
Insights
This study modified Swan-Ganz catheterization to assess liver function in patients with anasarca. The technique provided valuable insights into hepatic dysfunction, aiding in the management of complex multisystem diseases.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
Background:
- Determining the cause of anasarca (generalized swelling) is challenging, often involving cardiac, pulmonary, or hepatic dysfunction.
- Standard Swan-Ganz catheterization is useful for cardiac assessment but limited in evaluating liver disease.
Purpose of the Study:
- To describe a modified Swan-Ganz catheterization technique for assessing hepatic vein pressures and venography.
- To evaluate the clinical utility of this modified approach in patients with anasarca and suspected multisystem disease.
Main Methods:
- Swan-Ganz catheter advanced into the hepatic vein before pulmonary artery insertion in 11 patients.
- Hepatic vein catheterization allowed for wedged hepatic venography and pressure measurements.
- Simultaneous assessment of cardiac and hepatic hemodynamics.
Main Results:
- All 11 patients presented with pulmonary hypertension.
- Three patients had isolated cor pulmonale; others had combined left and right heart failure.
- Six patients showed signs of cirrhosis or portal hypertension on venography, with three lacking prior clinical liver disease diagnosis.
Conclusions:
- This modified catheterization provides additional, clinically useful information for identifying hepatic dysfunction in anasarca patients.
- It aids in managing cirrhosis complications and understanding pathophysiology in acute multisystem disease.
- While not proving improved outcomes, the technique offers valuable diagnostic insights with low risk.
Abstract:
In patients with anasarca, the relative importance of cardiac, pulmonary and/or hepatic dysfunction is often difficult to determine. Conventional use of the Swan-Ganz catheter helps to separate the contributions of right and left heart disease, but it is seldom used to evaluate liver dysfunction. This report describes passage of a Swan-Ganz catheter into the hepatic vein prior to pulmonary artery placement in 11 patients. Hepatic vein catheterization permitted wedged hepatic venography using contrast media and measurement of the wedged and free hepatic venous pressures. All 11 patients had pulmonary hypertension; three had cor pulmonale only, and the others had combinations of left and right heart failure. In addition, six patients had either a cirrhotic pattern on venography, or portal hypertension. Only three of these six patients had previous clinical evidence of liver disease. This study does not prove that identification of hepatic dysfunction by this method improves the outcome in such patients. However, this low risk modification of standard pulmonary artery catheterization provides additional information which is clinically useful in searching for and avoiding complications of cirrhosis, as well as offering a clearer understanding of pathophysiology in acute multisystem disease.