Inflation of the balloon allowed wedged hepatic pressure measurement. A pediatric CVK (Arrow® International) was placed in the portal vein for blood pressure monitoring

and blood sampling. No catheters were placed in the pigs in the chronic series, as the main objective here was to anastomose the shunt from the aorta to the left portal vein branch with minimal damage to the hepatic hilus. Measurements Acute series Calibrated transducers (Transact 3™, Abbott Critical Care Systems, Chicago, IL, USA) were used for continuous pressure registration and signals were CA4P clinical trial stored electronically (Macintosh Quadra 950, Apple Computers, CA, USA). Perivascular ultrasonic flow probes (CardioMed Systems, Medistim A/S, Oslo, Norway) were placed 4SC-202 purchase around the portal vein, right hepatic artery,

left hepatic artery and around the aortoportal shunt. Cardiac output was measured by thermo dilution (Vigilance™ Volumetrics, Edwards Lifesciences™). Measurements were made in triplicate and averaged. The heart rate was monitored with an electrocardiogram (ECG). Chronic series The heart rate was monitored with an ECG. Flow in the aortoportal shunt was measured using an 8 mm perivascular ultrasonic flow probe (CardioMed Systems, Medistim A/S, Oslo, Geneticin Norway). Surgery Acute series After ID-8 a midline laparotomy and placement of all catheters and flow probes as described above, we isolated and recorded the flow in the left portal vein branch (LPVB). When the activated clotting time (ACT) was above 250 seconds, a 5 mm Propaten Gore-Tex™ graft was anastomosed end-to-side from the aorta (between truncus coeliacus (TC) and the superior mesenteric artery (SMA)) to the LPVB. The LPVB was then ligated

proximal to the bifurcation to prevent backflow to the main portal vein trunk (MPVT). The opening of the shunt was regarded as time = 0 and noted. Flow in the shunt was standardized in each experiment to 1000 mL/minute by gradual shunt constriction using a ligature and a perivascular flow probe (Fig. 1). Sham surgery consisted of all the steps above except for the establishment of the aortoportal shunt. Chronic series After a midline laparotomy, a similar shunt was placed from the aorta to the LPVB once the animal had received 5000 IE heparin i.v. We used an interposed aorta graft from a donor pig (as the Gore-Tex grafts™ tended to become occluded). The LPVB was ligated proximal to the portal bifurcation to prevent backflow to the MPVT. Flow was standardized (by concentric constriction with a ligature) to 1000 mL/minute. Upon relaparatomy three weeks later, the shunt was isolated and flow measured. The flow in the MPVT (now supplying the right liver only) was recorded.