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Original communication| Volume 83, ISSUE 2, P181-187, February 1978

Effect of peritoneovenous shunting with the LeVeen valve on ascites, renal function, and coagulation in six patients with intractable ascites

  • Joseph D. Ansley
    Correspondence
    Reprint requests: Joseph D. Ansley, M.D., Emory University School of Medicine and Clinical Research Facility, Atlanta, GA 30322.
    Affiliations
    From the Departments of Surgery and Medicine, Emory University School of Medicine Atlanta, Ga U.S.A.

    From Clinical Research Facility, Emory University Hospital, Atlanta, Ga U.S.A.
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  • Robert A. Bethel
    Affiliations
    From the Departments of Surgery and Medicine, Emory University School of Medicine Atlanta, Ga U.S.A.

    From Clinical Research Facility, Emory University Hospital, Atlanta, Ga U.S.A.
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  • P.Allen Bowen II
    Affiliations
    From the Departments of Surgery and Medicine, Emory University School of Medicine Atlanta, Ga U.S.A.

    From Clinical Research Facility, Emory University Hospital, Atlanta, Ga U.S.A.
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  • W.Dean Warren
    Affiliations
    From the Departments of Surgery and Medicine, Emory University School of Medicine Atlanta, Ga U.S.A.

    From Clinical Research Facility, Emory University Hospital, Atlanta, Ga U.S.A.
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DOI:https://doi.org/10.5555/uri:pii:0039606078902763
Effect of peritoneovenous shunting with the LeVeen valve on ascites, renal function, and coagulation in six patients with intractable ascites
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      Abstract

      This study was aimed to determine the effectiveness of peritoneovenous shunting with the LeVeen valve in relieving resistant ascites, to identify renal hemodynamic changes caused by the shunt, and to recognize complications of the shunting procedure. Six patients with ascites unresponsive to sodium and water restriction, bed rest, and administration of diuretics received peritoneovenous shunts. All six had considerable or complete resolution of ascites. Three patients, followed from 41 to 62 weeks, have had improvement in their nutritional status with 10%, 32%, and 32% increases in their daily creatinine excretion, indicating comparable increases in muscle mass. Endogenous creatinine clearance increased from 60 ml/minute ±7.7 (mean ± SEM) prior to operation to 77 ± 11.1 after operation (P < 0.05). Plasma aldosterone fell in the four patients studied from 82 ng/100 ml ± 21.7 (mean ± SEM) before operation to 16 ± 4.1 after operation (P < 0.025). Spontaneous 24-hour urine sodium excretion improved in only two off five patients, but sodium excretion in response to diuretics increased from 29 mEq/day ± 11.8 (mean ± SEM) before operation to 112 ± 22.1 after operation (P < 0.01). Untoward postoperative complications were consumptive coagulopathy with associated gastrointestinal bleeding, two patients; central venous congestion, three patients; fever, three patients. We conclude that the shunting procedure is effective in relieving resistant ascites and that it is associated with an increased glomerular filtration rate, decreased secondary hyperaldosteronism, and possible increased effective plasma volume. The autoinfusion of ascites with this shunt frequently is complicated by consumptive coagulopathy, central venous congestion, and fever.
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      Article info

      Publication history

      Accepted: April 12, 1977

      Footnotes

      ☆This investigation was supported by U.S. Public Health Service grants AM 15736 and RR00039.

      Identification

      DOI: https://doi.org/10.5555/uri:pii:0039606078902763

      Copyright

      © 1978 Published by Elsevier Inc.

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