Federal Republic of Germany and Abteilung fur Pathophysiologie der I. Medizinischen Klinik des Klinikums, 0-6800 Mannheim, Federal Republic of Germany Cardiovascular alterations such as increased heart rate, high cardiac output, reduced systemic vascular resistance, and in most of the cases, increased contractility parameters have been recognized in patients with advanced liver disease.
Some investigators define a cirrhotic cardiomyopathy as a hyperdynamic failure of the heart. Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. After opening a portocaval shunt, it is expected that a large amount of blood will be distributed from the splanchnic to the pulmonary circulation and put a strain on the heart.
This two-dimensional echocardiographic study was made in 30 patients with cirrhosis and in 20 patients who were chronically treated (range: 16 to 166 months) with portasystemic shunt for prevention of hemorrhage from esophageal variceal bleeding. Patients with portasystemic shunts revealed a change in hemodynamic pattern. There was a significant increase in the left ventricular end-diastolic volume index and also a slight increase in the left ventricular end-systolic index. Cardiac output remained high despite a significant decrease in heart rate due to an elevated left ventricular stroke volume index. The parameters of systolic ventricular performance were normal.
In contrast to the acute opening of the portacaval shunt, the chronic shunt volume put no strain of clinical significance on the heart.
Studies of the cardiovascular system in patients with cirrhosis (CI) (1-13) have shown that hyperkinetic circulation is frequently present. Some investigators define the cirrhotic cardiomyopathy as the hyperdynamic unloaded failure of the heart (14,15). Pathological studies reveal cardiac hypertrophy and areas of myocardial fibrosis (16).
Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. Normally, the splanchnic vascular bed plays an important role as volume reservoir. After opening of a portocaval shunt, it is expected that a large amount of