Validity of transhepatic pulp pressure measurements

Cineangiographic studies were undertaken in conjunction with pressure measurements to determine the reliability of transhepatic pulp pressure manometry in assessing portal pressure. Pressure measurements obtained by wedged hepatic vein and/or umbilical-portal vein catheterization were used as a reference. An accurate index to intrasinusoidal pressure was provided when the needle was introduced into the sinusoidal bed and created a vascular “puddle.” Pressures were inaccurate when the needle entered a hepatic venule, the subcapsular space, or a bile duct. Reversible increases in transhepatic pressure were noted with proliferation of sinusoidal-mesenchymal cells attendant to acute liver injury or hyperplasia of the endoplasmic reticulum following administration of drugs that are metabolized in microsomes.