Use of hepatic vein catheterization in the evaluation of patients with anasarca

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. Th...

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Bibliographic Details
Published in:	The American journal of the medical sciences Vol. 299; no. 4; p. 245
Main Authors:	Insel, J M, Mookherjee, S, Smulyan, H, Warner, R A
Format:	Journal Article
Language:	English
Published:	United States 01-04-1990
Subjects:	Ascites - diagnosis Ascites - etiology Catheterization, Swan-Ganz Edema - complications Edema - diagnosis Edema - etiology Heart Failure - complications Hemodynamics Hepatic Veins - diagnostic imaging Hepatomegaly - complications Hepatomegaly - diagnosis Humans Hypertension, Portal - complications Hypertension, Portal - diagnosis Liver Cirrhosis, Alcoholic - complications Liver Cirrhosis, Alcoholic - diagnosis Phlebography Venous Pressure
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Summary:	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.
ISSN:	0002-9629
DOI:	10.1097/00000441-199004000-00005