Herrmann, TJ

Marchioro, TL

Starzl, TE

Taylor, PD

English

PubMed

Name not available

Oxygen and CO2 content in the splanchnic and nonsplanchnic blood of dogs with portacaval transposition

D-Scholarship@Pitt

li(.r)rintt-,l frorii ST-RGERY, St. Louis Vol. 60 ,  No. 6,  Pages 1 2 2 9 - 1 2 3 1 ,  Det'el~iher, 1 9 6 6 .  (P r in ted  in the I:. S. A. )  (Copyright 0 1 9 6 6  by The  C. 1. hlosby Co~nDany) Oxygen and C02 content in the splanchnic and nonsplanchnic blood THOMAS J. HEKKMANN, M.D." PAUL D. TAYLOK THOMAS L. MARCHIORO, M.D.*" of dogs with portacaval THOMAS E. STARZL, M.DI, PH.D. DENVER, COLO. transposition I t has often been stated that the oxygen content of the portal venous blood is higher than that found in the inferior vena cava. In  the present studies this concept has been tested. and found to be invalid in unanes- thetized, resting dogs subjected to prior portacaval transposition. METHODS Thirteen mongrel dogs, weighing 10 to 20 kilograms each, received portacaval trans- position' under total body hyp~thermia .~  During convalescence, they were trained to lie quietly in a lateral position. From 11 to 106 days postoperatively, the dogs were fasted at intervals of 12 to 18 hours, and catheters were inserted under local anesthesias into the suprarenal inferior vena cava, the proxi- mal portal vein, the left hepatic vein, and a peripheral artery. The position of the venous catheters was fluoroscopically controlled. Af- ter a lesting state was achieved, time-inte- ?rated blood samples were simultaneously drawn, and subsequently analyzed by the manometric Van Slybe method for oxygen content. Ninc of the dogs also had Van Slyhe CO, determinations performed. Hema- tocrits \\ere routinrly done. At autopsy, the From the Department  of Surgery, the University of Colorado School of Medicine, and the Uenuer Veterans Administration Ho.rpita1 patency of the venous anastornoses was proved. RESULTS The results of the gas analyses are shown in Table I .  Although there was some varia- tion in results, the over-all pattern was con- sistent. The arterial oxygen concentration was greatest, as would be expected. The oxy- gen concentration in the hepatic venous blood was lowest. The  oxygen saturation of the suprarenal vena cava was higher than that of the portal vein in 12 of 13 animals. The only exception was in Dog 10, who had a significant hemorrhage at  the time of ar- terial catheterization. The difference between the vena caval blood and the portal venous blood was significant ( p  < 0.005). I t  was also noted that in all but two of the ani- mals, the CO, content of the portal blood was either equal to or higher than that in the vena caval samples. DISCUSSION There seems little doubt that in patients with cirrhosis of the liver and portal hyper- tension the oxygen content is higher in the splanchnic veins than in the systemic veins1, 5 ,  Most authors have suggested that Aided by Glants AM 06283, AM 06344, HE 07735, AM this is due to arteriovenous shunting within 07i72, A1 04152. FR 00051, and FR 00069 from the the nonhepatic splanchnic system. United States Public Health Sel-vic?. Submitted for publication May 13, 1966; resubmitted The origin of the belief that the same June 14, 1966. situation exists in the healthy dog is less "Present addt.css: Unive~..;ity of Micliigan Hospital, Ann A, bor. Micll. clear. The classical work of Blalock and .. .. ;T;rhiat kle Scholar. Mason2 has often been quoted in support of V o l .  60, No .  6 ,  pp .  1229-1231 December, 1966 S U R G E R Y  1229 1230 Hr:rrmann et al. Surgery December 1966 Table I .  Oxygen  and carbon dioxide in volumes percent 2 125 44 32.84 16.74 40.75 8.29 34.52 13.16 37.87 9.98 3 99 3 3 - - 42.26 9.48 45.20 8.64 43.95 5.95 4 96 3 6 33.88 12.39 37.36 10.15 36.13 10.48 37.37 7.00 5 * 14 2 8 24.63 14.61 25.54 12.20 28.34 10.47 29.99 7.14 6 14 41 28.68 15.25 34.15 9.41 31.62 11.90 32.97 8.95 7 14 45 33.93 16.21 36.24 11.97 36.31 14.09 36.98 11.67 8 14 3 5 31.87 13.97 36.71 7.96 33.86 11.83 35.15 8.26 9 15 44 33.89 16.73 41.08 13.44 36.07 15.58 35.79 12.25 10 11 45 34.76 14.82 40.18 8.48 38.20 12 20 38.66 8.76 11 12 46 29.06 17.16 33.30 13.97 32.40 16.20 34.00 13.70 12 12 45 30.50 15.57 35.44 9.73 34.66 14.25 34.89 11.62 13 12 44 34.00 15.89 38.63 10.28 37.09 12.70 36.96 10.89 Average 40.5 31.64 15.33 36.80 10.42 35.36 12.55 36.21 9.48 Standard deviation 5.7 3.1 1.4 4.5 1.9 4.1 2.1 3.4 2.4 "Significant hemorrhage during vessel catheterization. Dog N o .  this idea, but in fact, these authors did not measure, and did not claim to have measured the oxygen concentration of the vena caval system. Instead, they studied the oxygen gradient across the liver. The vena caval samples analyzed by them were from a tem- porarily isolated segment into which only the hepatic veins drained. Only two pertinent studies about dogs arc available, those of Womack and Petersg and Hardin, Shumaker, and Sheng S U . ~  The for- mer investigations were carried out under anesthesia, and were part of a protocol which involved considerable manipulation of the portal structures, as well as intermittent oc- clusion of the portal vein. Under these cir- 1 106 41 - 14.62 - 10.15 - 11.76 - 7.10 Hematocrit Day fiortop. (5%) cumstances, the oxygen concentration in the splanchnic blood was consistently higher tlian that in the inferior vena cava. Similarly, the dogs studied by Hardin and associates4 were examined one day after operative placement of catheters. The portal venous concentration averaged 76 percent, as compared to 49 per- cent in the femoral vein. The unusually de- saturated state of the latter samples raises some doubt about the physiologic normalcy of the animals a t  the time of measurement. In  addition, the site of peripheral sampling does not necessarily reflect the oxygen con- tent in the suprarenal inferior vena cava. Under the conditions of our study, the blood in the portal vein actually was more A r t e r ~ a l  Portal uein V e n a  caun Hepat ic  uein CO? 0 2  C O ,  0, CO, 0 2  I COZ 0 2  desaturated than that in the portion of the inferior vena cava, which had received venous effluent lrom the hindquarters, lower trunk, and kidneys. Thus, a liver revascular- ized by means of portacaval transposition has a resting venous inflow of at least as high oxygen saturation, and probably higher than that of the diverted distal portal vein. These findings stress the necessity of repeating earlier studies of the portal and systemic oxygen saturation in unaltered dogs under more satisfactory conditions of testing than those employed in the past. I t  is possible that portacaval transposition alters the physiology of oxygen transport in the splanchnic bed, thus accounting for the results herein re- ported. Alternatively, however, it is conceiv- able that a lower systemic oxygen content as opposed to the portal oxygen content would not exist in normal animals, providing they were tested after full recovery from op- eration. SUMMARY The oxygen and CO, content of unanes- thetized fasting dogs was studied from 2 to 14 weeks after portacaval transposition. The splanchnic venous oxygen content was gen- erally somewhat less tlian the oxygen con- tent in the suprarenal inferior vena cava. The CO, content tended to be greater. These findings challenge the validity of the com- V o l u ~ ~ ~ e  60 Number 6 Portncnunl trans,t~ocition and O2 and CO, in  blood 1231 mon assulrlptiorl that portal venous blood has a higher oxygen content than that of mixed systemic vcnous blood obtained from the inferior vena cava. REFERENCES 1. Berman, E. J., and Habegger, E. D.: Vascular crisis in atrophic cirrhosis of the liver, Wis- consin M. J. 51: 1175, 1952. 2. Blalock, A. ,  and Mason, M. F.: Observations on the blood flow and gaseous metabolism of the liver in unanesthetized dogs, Am. J. Physiol. 117: 328, 1936. 3. Child, C. G., 111, Barr, D., Holswade, G. R., and Harrison, C. S.: Liver regeneration fol- lowing portacaval transposition in dogs, Ann. Surg. 138: 600, 1953. 4. Hardin, R.  A,, Shumaker, H. B., Jr., and Sheng Su, C.: Studies on portal venous oxy- gen saturation, Arch. Surg. 87: 831, 1963. 5. Liebowitz, H .  R.: Bleeding esophageal varices: Portal hypertension, Springfield, Ill., 1959, Charles C Thornas, Publisher, pp. 321-323. 6. Smythe, C. N., Fitzpatrick, H. F., and Blake- more, A. H.: Studies of portal venous oxygen content in unanesthetized man, J. Clin. Invest. 39: 674, 1951. 7. Starzl, T. E., Butz, G. W., Jr., and Munger, D.  H.: A technique for portacaval transposition (addendum), J .  Surg. Res. 1: 218, 1961. 8. Starzl, T. E., Lazarus, R. E., Schlachtcr, I,., Thornton, F. H. ,  Wendel, R. M., Stearn, B., and Scanlon, W. A.: A multiple catheter tech- nique for studies of hepatic metabolism and blood flow in dogs with portacaval transposi- tion, SURGERY 52: 654, 1962. 9. Wonlack, N. A,, and Peters, R. M.: An in- vestigation of the relationship between portal venous pressure and inferior vena caval and portal venous oxygen saturations, Ann. Surg. 146: 691, 1957. 

Oxygen and CO-2 content in the splanchnic and nonsplanchnic blood of dogs with portacaval transposition.

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Oxygen and CO-2 content in the splanchnic and nonsplanchnic blood of dogs with portacaval transposition.

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