To the Editor.—
The Denver peritoneovenous shunt, with its valved pump chamber and heparin-bonded tubing, may offer prolonged patency when compared with other types of peritoneovenous shunts. However, shunt thrombosis is a troublesome complication that usually requires operative revision.The patient with intractable ascites secondary to hepatic cirrhosis presents a therapeutic challenge. Even though the additional volume load imposed by a peritoneovenous shunt may be hemodynamically tolerated, a reduced peritoneovenous pressure gradient decreases flow through the shunt and puts the paient at high risk for thrombosis of the venous end of the tubing. We recently treated such a patient.
Report of a Case.—
A 63-year-old man had, in addition to medically intractable ascites from biopsy-proved Laennec's cirrhosis, multiple medical problems including mild right-sided heart failure associated with previous myocardial infarction and atrial fibrillation. Because of his chronically elevated central venous pressure (30 mm Hg), he was followed up expectantly until