Plasma Atriopeptin before and after Peritoneojugular Venous Shunt for Hepatogenic Ascites

To the Editor: To shed light on the disputed role of vascular “underfill” versus “overflow” in the origin and perpetuation of hepatogenic ascites,¹ we measured plasma levels of atriopeptin (atrial natriuretic factor), a saluretic cardiac hormone stimulated by right atrial distention,² before and after insertion of a peritoneojugular (LeVeen) shunt. In five dogs, the thoracic inferior vena cava was constricted to 50 percent of its circumference, and the azygos vein was ligated (an experimental preparation of “congestive cirrhosis”).³ Two weeks later, when the ascites was massive, a peritoneojugular shunt was inserted in four dogs; after ascites mobilization (7 to 10.