Liver Function in Advanced Heart Disease.

Anatomical and functional damage to the liver have been demonstrated in patients with heart failure (Sherlock, 1951; White et al., 1951, 1955), but the relation between histological and biochemical changes is not close. We have repeatedly observed evidence of liver failure occurring unexpectedly after an uneventful operation for advanced heart disease, and this suggested that the study of liver function by sensitive and varied methods in patients with differing degrees of congestion of the liver might throw some light on the mechanism of the liver disorder and might indicate a method of selecting the patients at risk from this complication of surgical treatment. This communication describes such a study. In addition to carrying out the routine tests of liver function, the technique of the diagnostic cardiac catheterization was modified to permit the estimation of hepatic blood flow with indocyanine green and the assessment of hepatic storage and transport function by means of the bromsulphthalein (BSP) infusion test. In certain patients these tests were repeated after the venous congestion had been relieved by medical or surgical treatment.