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AIM: To study the changes of portal blood flow in congestive heart failure.METHODS: We studied the congestion index (CI) and portal vein pulsatility index (PI) in patients with varied degrees of congestive heart failure using ultrasonic Doppler. Ten patients with mean right atrial pressure (RA)＜10 mmHg were classified as group 1 and the remaining 10 patients with RA≥ 10 mmHg as group 2.RESULTS: There were no difference on cardiac index (HI,P= 0.28), aortic pressure (AO, P= 0.78), left ventricular end-diastolic pressure (LVED, P= 0.06), maximum portal blood velocity (Vmax, P= 0.17), mean portal blood velocity (Vmean, P=0.15) and portal blood flow volume (PBF,P=0.95) between the two groups. Group 2 patients had higher pulmonary wedge pressure (PW, 29.9 ± 9.3 mmHg vs 14.6 ± 7.3 mmHg, P= 0.002), pulmonary arterial pressure (PA, 46.3 ± 13.2 mmHg vs 25.0±8.2 mmHg,P=0.004), RA (17.5±5.7 mmHg vs 4.7 ± 2.4 mmHg,P＜ 0.001), right ventricular end-diastolic pressure (RVED,18.3±5.6 mmHg vs 6.4±2.7 mmHg, P＜0.001), CI(8.7±2.4 vs 5.8± 1.2, P=0.03), and PI (87.8±32.3% vs27.0±7.4%, P＜0.001) than Group 1. CI was correlated with PI (P＜0.001), PW (P＜0.001), PA (P＜0.001),RA (P=0.043), RVED (P=0.005), HI (P＜0.001), AO(P＜0.001), CO (P＜0.001), LVED (P＜0.001), Vmax(P＜0.001), V (P＜ 0.001), cross-sectional area of the main portal vein (P＜0.001) and PBF (P＜0.001). CI could be as high as 8.3 in patients with RA＜ 10 mmHg and as low as 5.9 in those with RA≥ 10 mmHg.CONCLUSION: Our data show that RI is a more significant indicator than CI in the clinical evaluation of high RA≥ 10 mmHg, whereas CI is better than PI in the assessment of left heart function.