Collection
Portal Hypertension in Pediatrics
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The mesoportal (Rex) shunt provides physiologic flow and is by far the number one preferred shunt option when possible. — Alex Bondoc, Portal Hypertension with Dr. Alex Bondoc · 7:27
Natural Course of Pediatric Portal Hypertension.
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The etiology of portal hypertension (pHTN) in children differs from that of adults and may require different management strategies. We set out to review the etiology, management, and natural history of pHTN at a pediatric liver center. From
article · Oct 2026
Portal Hypertension with Dr. Alex Bondoc
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This is another episode of the StayCurrent Podcast.
Here we cover all the important things you need to know about Portal Hypertension. And for that we have the expert Dr. Alex Bondoc, a pediatric surgeon from Cincinnati Children's Hospi
podcast11:44 · Aug 2023
The role of surgical shunts in the treatment of pediatric portal hypertension
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Background: Portal diversion by surgical shunt plays a major role in the treatment of medically refractory portal hypertension. We evaluate our center's experience with surgical shunts for the treatment of pediatric portal hypertension. Met
article · Oct 2026
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Portal Hypertension with Dr. Alex Bondoc
Portal hypertension is defined as a hepatic venous portal wedge pressure of greater than 5 millimeters of mercury.
clinicalAlex Bondoc0:53 ↗
Portal hypertension develops when resistance to portal blood flow increases.
clinicalAlex Bondoc0:53 ↗
In prehepatic portal vein thrombosis, the vast majority of pediatric patients have no predisposition to clotting despite hematology workup.
clinicalAlex Bondoc1:20 ↗
Biliary atresia is the number one cause worldwide of pediatric liver transplantation.
epidemiologicalAlex Bondoc1:20 ↗
The most common clinical manifestation of portal hypertension is GI bleeding due to esophageal varices.
clinicalAlex Bondoc2:31 ↗
After the first episode of GI bleeding, the risk of complications including rebleeding, ascites, spontaneous bacterial peritonitis, and conditions associated with end-stage liver disease continues to occur.
clinicalAlex Bondoc2:31 ↗
Higher incidence of bleeding occurs with a wedge pressure of greater than 12 mmHg.
clinicalAlex Bondoc3:02 ↗
Portal vein velocity decreases in severe portal hypertension as intrahepatic resistance increases.
clinicalAlex Bondoc3:47 ↗
In transient elastography, a pressure greater than 15 kilopascals is highly suggestive of portal hypertension.
clinicalAlex Bondoc3:47 ↗
At Cincinnati Children's, varices are graded 1 through 4, where grade 4 means the entire esophagus is essentially collapsed, grade 3 is 2/3 collapsed, grade 2 is 1/3 collapsed, and grade 1 is just ridges under the mucosa.
clinicalAlex Bondoc5:09 ↗
Primary prophylaxis is not performed in pediatric patients with portal hypertension at Cincinnati Children's.
clinicalAlex Bondoc5:39 ↗
The Baveno 7 recommendations recommend against factor 7 use in acute variceal bleeding.
Host summaryCecilia Gigena summarizes what Dr. Alex Bondoc said — not the host's own clinical position5:52 ↗
Baveno recommendations are made for adult patients, except for Baveno 5.
Host summaryCecilia Gigena summarizes what Dr. Alex Bondoc said — not the host's own clinical position5:52 ↗
Octreotide can work well for esophageal varices but not as well for gastric varices or portal hypertensive gastropathy.
clinicalAlex Bondoc6:25 ↗
Data suggests that carvedilol might be a better option than propranolol for non-selective beta blockade in portal hypertension.
clinicalAlex Bondoc6:25 ↗
All patients with acute variceal bleeding should be started on IV antibiotics because of the high risk for bacterial translocation.
clinicalAlex Bondoc6:25 ↗
Patients with end-stage liver disease should not be shunted and should go to liver transplant instead.
clinicalAlex Bondoc7:05 ↗
The mesoportal (Rex) shunt provides physiologic flow and is by far the number one preferred shunt option when possible.
opinionAlex Bondoc7:27 ↗
For prehepatic disease, a messorex shunt is the preferred option.
clinicalAlex Bondoc8:44 ↗
For hepatic disease, options include distal splenorenal shunt, central splenorenal shunt, or mesocaval H-type shunt.
clinicalAlex Bondoc8:44 ↗
For posthepatic disease, options include H-type mesocaval shunt, TIPS, or atrial caval shunt.
clinicalAlex Bondoc8:44 ↗
If platelet count starts dropping during follow-up, there is probably something wrong with the shunt.
clinicalAlex Bondoc9:23 ↗
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