Coronary venous variation in patients with portal hypertension

Objectives To observe the changes in the anatomic variation and the hepatofugal flow of coronary vein and to evaluate the clinical significance of these changes in patients with portal hypertension. Methods The anatomic variations and the retrograde flow of the coronary vein, and the portal antegrade flow and the portal pressure were observed by direct and indirect portography, direct measurement of portal pressure and Doppler sonography in 200 cirrhotic patients with portal hypertension. Results Single branch and two branches of the coronary vein were noted in 79 46% and 20 54% of the patients with portal hypertension respectively by direct portography. The sites of coronary vein arising from the portal vein, splenic vein or portosplenic junction were found in 62 33%, 27 35% or 8 07% respectively. The confluence of coronary vein and portal vein was found in most patients with variceal bleeding and recurrent bleeding after devascularization. The confluence of the coronary vein and splenic vein was observed in most patients with refractory ascites without variceal bleeding.Arterial portography demonstrated retrograde opacification of the coronary vein in 26 19% (grade Ⅱ portal venous pattern),56 64% (grade Ⅲ portal venous pattern ),100% (portal thrombosis and action bleeding) 47 79% (controuing periods of bleeding), and 19 05% (refractory ascites). Conclusions The anatomic variation of the coronary vein may be related to variceal bleeding in cirrhotic patients with portal hypertension and the retrograde opacification of the coronary vein is a significant sign of variceal bleeding.