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This case demonstrates how Transit Time Flow Measurement (TTFM) can be used during liver transplant surgery as a guide when modulating the portal venous flow (PVF) to avoid hepatofugal flow.
Liver Tx: Guiding inflow modulation with TTFM
Case story
Hepatofugal flow or non-forward portal flow (NFPF) describes a blood flow that is directed away from the liver. Hepatofugal flow in the portal venous system is, with few exceptions, always pathological. Detection of NFPF is important as it has been shown to be associated with poorer clinical outcome after liver transplantation. See image 1.
Intraoperative completion control with TTFM
The TTFM tracings below show the flow in the portal vein and the hepatic artery. The PVF was lower than excpected, only 969 mL/min, and a spleno-renal shunt was identified. This shunt caused hepatofugal flow. See image 2.
After closure of the spleno-renal shunt, PVF improved to 1,808 mL/min. Reduced hepatofugal flow increases the chance for graft survival. See image 3.
This case shows how TTFM is used when modulating the portal venous flow to secure optimal graft function and patency during liver transplant surgery.
Case attachments
Click images below to view.
Illustration of hepatofugal flow
TTFM in the portal vein and hepatic artery before closure of the spleno-renal shunt
TTFM in the portal vein and hepatic artery after closure of the spleno-renal shunt
Technology used
Medistim MiraQTM Vascular System with TTFM probes (PV series).
