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To define the respective role of portal venous flow and of portal vascular resistance in the initiation and maintenace of portal hypertension, 49 cases of cirrhosis were studied by portal and hepatic vein catheterization in comparison with 21 normal subjects and 5 patients with chronic persistent hepatitis. Portal venous flow, splenic venous flow, portal vascular resistance and intrahepatic shunt index were measured. In conclusion: The increase of portal vascular resistance as fibrosis and nodule formation, is primarily responsible for the beginning portal hypertension and its perpetuation. Subsequently, in some cases an increase of portal venous flow partly due to spillover of the increased splenic venous flow, a natural outcome of hyperplasia of the spleen plays a role in the maintenace of portal hypertension despite the reduction of portal vascular resistance following development of intrahepatic shunt.