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[Portal blood flow studied in children with portal hypertension using Doppler duplex echocardiography]
A M López Barrio1, M A de Palma Gastón, J Muñoz Conde
1Servicio de Radiodiagnóstico, Hospital Infantil Universitario Virgen del Rocío, Sevilla.
Insights
Doppler duplex echography non-invasively assesses portal hypertension in children. This method reveals decreased portal blood flow velocity and volume in affected children, aiding early diagnosis and monitoring.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Vascular Biology
Background:
- Portal hypertension arises from altered venous portal system circulation.
- Symptoms are linked to these circulatory changes.
- Non-invasive assessment is crucial for pediatric patients.
Purpose of the Study:
- To evaluate Doppler duplex echography for studying portal morphology and hemodynamics in children.
- To assess the efficacy of this technique in diagnosing and monitoring portal hypertension.
Main Methods:
- Utilized Doppler duplex echography to examine portal vein and hepatic artery in 83 children.
- Children categorized into biliary atresia, portal cavernoma, neonatal hepatitis, and healthy groups.
- Analyzed parameters including blood flow velocity, volume, and indices of congestion and resistance.
Main Results:
- Children with portal hypertension showed reduced respiratory variation in portal blood flow velocity and volume compared to healthy controls.
- No significant differences were observed in portal vein size or hepatic artery resistance index.
- Neonatal hepatitis group exhibited normal hemodynamic parameters.
Conclusions:
- Doppler duplex echography is highly effective for diagnosing and managing pediatric portal hypertension.
- The technique enables early detection of portal hypertension, even in asymptomatic children.
- It provides a valuable tool for follow-up and monitoring of the condition.
Unlabelled:
The study of portal morphology and hemodynamics is due the fact that the principle symptoms of portal hypertension are due primarily to alterations in the circulation of the venous portal system. The Doppler duplex echography (bidimensional echography in real time plus pulsatile Doppler) allows one to study these circulatory alterations in a non-invasive manner.
Material And Method:
For these studies, an echograph (Toshiba, model Sonolayer SSH-60A) was used to study the morphology and the blood flow of the portal vein and the hepatic artery in 83 children. These children were divided into 4 groups: a) 9 children with atresia of the biliary ducts, b) 11 children with cavernoma of the portal vessel, c) 5 children with neonatal hepatitis and d) 58 healthy children. The parameters studied included the calibre, cross-sectional area, perimeter, velocity, blood flow volume, index of congestion and fluctuation and the direction of the portal flow, as well as the index of resistance of the hepatic artery.
Results:
The results obtained in groups a, b and c were compared to healthy children of the same weight. When compared to normal children, it was found that children with portal hypertension had a decrease in the velocity and volume of the blood flow with respiration. There were no differences in the size of the portal vein nor in the index of resistance of the hepatic artery. The values obtained in children with neonatal hepatitis did not differ from those found in healthy children.
Conclusions:
We conclude that the Doppler duplex echography is an excellent method for the diagnosis and follow-up of portal hypertension, as well as for the detection of this condition early in asymptomatic patients.