Death after portal decompressive surgery. Physiologic state, metabolic adequacy, and the sequence of development of the physiologic determinants of survival
J. H. Siegel, I. Giovannini, B. Coleman, F. B. Cerra and A. Nespoli
Detailed serial cardiovascular and respiratory physiologic studies were
carried out in 80 patients with cirrhotic liver disease, including 45
cirrhotic patients who underwent portal decompressive surgery on an urgent
or elective basis. In surgical cases, death could be predicted from the
first postoperative day's pattern of response. Predictors of death were an
increase in percent of pulmonary shunt due to a redistribution of the
increased pulmonary blood flow, and a disproportionate fall in vascular
tone, which permits an increased cardiac ejection fraction even when
significant myocardial depression occurs. The etiology of the vascular tone
defect seems related to the rise in levels of the false neurotransmitter
octopamine, which are shown to increase as oxygen consumption falls in the
patho-physiologic hyperdynamic B state, presumably due to a block in the
oxidative metabolism of aromatic amino acids.
