Hepatic artery and portal vein contribute to the hepatic blood inflow. Congestive heart failure and systemic hypotension can decrease cardiac output. The reduced cardiac out put and systemic hypotension can decrease the portal inflow volume.Portal flow contributes to 75% of blood flow and 50% of oxygen supply of the liver. As marked reduction of hepatic inflow may cause ischemic hepatitis, patients with cardiopulmonary diseases may develop ischemic hepatitis with abnormal serum ALT levels. On the other hand, right-sided congestive heart failure can result in the increase of pressure in inferior vena cava and hepatic veins.The diameter of portal vein has been proved to correlate with right atrial pressure. Thus, right-sided heart failure can affect portal vein flow patterns(1).Heart disease can alter liver volume, morphology and circulation. The Doppler pulsatility of the portal vein and its pulsatility ratio are closely associated with right atrial pressure and with New York Heart Association classification of heart failure. Portal vein pulsatility ratio is a more reliable method of assessment of right heart failure than morphological measurement of dilated inferior vena cava and hepatic veins(2).