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Transmitted Cardiac Pulsations as an Indicator of Transjugular Intrahepatic Portosystemic Shunt Function: Initial Observations¹

¹ From the Departments of Radiology (R.G.S., T.V., D.P.B.) and Neurology (B.J.R.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215. Received August 9, 2001; revision requested September 19; revision received November 5; accepted January 7, 2002. Address correspondence to R.G.S. (e-mail: rsheiman@caregroup.harvard.edu).

View larger version (86K): [in a new window]   Figure 1. Oblique US image shows baseline spectral analysis of a TIPS in a 55-year-old woman with a history of alcohol-related cirrhosis. Note waveform pulsatility from transmitted cardiac pulsations. Crosshairs denote the maximum and minimum velocities during one cycle used to calculate a venous pulsatility index (VPI) of 0.50.

View larger version (84K): [in a new window]   Figure 2a. (a) Oblique US image shows baseline spectral analysis of a TIPS interrogated at the stent-hepatic venous junction in a 62-year-old woman with primary biliary cirrhosis. Waveform pulsatility is present (VPI = 0.32). Follow-up oblique Doppler US images show interval loss of pulsatility (b) at the stent-hepatic venous junction (VPI = 0.13) and (c) in the middle of the stent (VPI = 0.07), despite acceptable velocities. Shunt dysfunction was confirmed at venography (not shown). (d) Oblique view obtained at repeat Doppler US after TIPS revision shows return of waveform pulsatility (VPI = 0.40). Crosshairs indicate the maximum and minimum velocities used to determine the VPI.

View larger version (121K): [in a new window]   Figure 2b. (a) Oblique US image shows baseline spectral analysis of a TIPS interrogated at the stent-hepatic venous junction in a 62-year-old woman with primary biliary cirrhosis. Waveform pulsatility is present (VPI = 0.32). Follow-up oblique Doppler US images show interval loss of pulsatility (b) at the stent-hepatic venous junction (VPI = 0.13) and (c) in the middle of the stent (VPI = 0.07), despite acceptable velocities. Shunt dysfunction was confirmed at venography (not shown). (d) Oblique view obtained at repeat Doppler US after TIPS revision shows return of waveform pulsatility (VPI = 0.40). Crosshairs indicate the maximum and minimum velocities used to determine the VPI.

View larger version (114K): [in a new window]   Figure 2c. (a) Oblique US image shows baseline spectral analysis of a TIPS interrogated at the stent-hepatic venous junction in a 62-year-old woman with primary biliary cirrhosis. Waveform pulsatility is present (VPI = 0.32). Follow-up oblique Doppler US images show interval loss of pulsatility (b) at the stent-hepatic venous junction (VPI = 0.13) and (c) in the middle of the stent (VPI = 0.07), despite acceptable velocities. Shunt dysfunction was confirmed at venography (not shown). (d) Oblique view obtained at repeat Doppler US after TIPS revision shows return of waveform pulsatility (VPI = 0.40). Crosshairs indicate the maximum and minimum velocities used to determine the VPI.

View larger version (112K): [in a new window]   Figure 2d. (a) Oblique US image shows baseline spectral analysis of a TIPS interrogated at the stent-hepatic venous junction in a 62-year-old woman with primary biliary cirrhosis. Waveform pulsatility is present (VPI = 0.32). Follow-up oblique Doppler US images show interval loss of pulsatility (b) at the stent-hepatic venous junction (VPI = 0.13) and (c) in the middle of the stent (VPI = 0.07), despite acceptable velocities. Shunt dysfunction was confirmed at venography (not shown). (d) Oblique view obtained at repeat Doppler US after TIPS revision shows return of waveform pulsatility (VPI = 0.40). Crosshairs indicate the maximum and minimum velocities used to determine the VPI.