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Coşarderelioğlu, Çağlar; Coşar, Arif; Gürakar, Merve; Pustavoitau, Aliaksei; Russell, Stuart D.; Dagher, Nabil N.; Gürakar, Ahmet

doi:10.6002/ect.2015.0351

“…90 O diagnóstico dessa condição envolve a realização de cateterismo direito para a confirmação de HAP, conforme previamente descrito, e a confirmação de hipertensão portal, via medida do gradiente de pressão trans-hepática superior a 4 mmHg. 91 O tratamento de HPOP foi avaliado através de pequenos estudos, que demonstraram benefício das três classes de fármacos alvo para HAP. A hepatotoxicidade dos AREs não parece ser um problema maior para essa população, desde que monitorizados adequadamente.…”

Section: Hipertensão Portopulmonarunclassified

“…A HPOP é um marcador de pior prognóstico perioperatório neste procedimento. 91 Valores de PMAP maiores do que 50mmHg contraindicam o transplante, e menores que 35mmHg indicam baixo risco de morte na realização do procedimento. 91 Dessa forma, é fundamental a realização de um ecocardiograma para rastreamento de HAP em pacientes na fila para transplante hepático, ou em pacientes com hipertensão portal e dispneia, mesmo que de pequena intensidade.…”

Section: Hipertensão Portopulmonarunclassified

Atualização no Tratamento da Hipertensão Arterial Pulmonar

Fernandes

¹

,

Calderaro²,

Assad

³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Muitos avanços ocorreram nas últimas décadas na terapêutica da hipertensão arterial pulmonar (HAP), uma doença grave, progressiva, incurável e potencialmente fatal. Para seu tratamento adequado, são fundamentais o diagnóstico hemodinâmico e a classificação de sua etiologia, em que várias delas (colagenoses, hipertensão portal, cardiopatia congênitas, esquistossomose) requerem medidas específicas, além do tratamento farmacológico característico para HAP.O tratamento com fármacos-alvo para HAP baseia-se em produtos farmacêuticos que interferem em três vias fisiopatológicas moleculares: da prostaciclina, da endotelina e do óxido nítrico. Tais fármacos apresentam múltiplas apresentações (oral, endovenosa, subcutânea e inalatória) e mudaram a história da HAP. Essas medicações e suas estratégias de uso, assim como particularidades das diferentes formas de HAP, são o foco desta revisão.

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Further Questions Regarding Electrocardiogram Prior to Liver Transplant

Bakinde

¹

,

Ajose

²

,

Chang

³

2018

JAMA Intern Med

0

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To the Editor We read with great interest the Challenges in Clinical Electrocardiography by Littman et al 1 published in a recent issue of JAMA Internal Medicine. The authors present the electrocardiogram (ECG) as a simple and inexpensive, yet powerful, tool for the early detection of portopulmonary hypertension (PPHTN). This case is very unique in that the development of PPHTN was very rapid and occurred after successful liver transplant. Various studies 2 have noted that the prevalence of PPHTN is 1% to 2% among patients with portal hypertension but increases to 5% to 8% in candidates for transplant. 2 Even so, given that PPHTN occurs 4 to 7 years after patients are diagnosed with portal hypertension, 3 the rapid progression of disease is interesting in the absence of what appears to be predisposing factors. One would imagine that successful liver transplant would have prevented this conversion from occurring, especially without any documented clinical evidence of portal hypertension.As Littman et al 1 have noted, we agree that the use of ECG is a simple, inexpensive, and powerful tool in the early detection of PPHTN. However, although a pretransplant ECG was noted to be normal, it is difficult to assess when this ECG was performed and whether any ECGs that may have been performed afterwards (prior to the posttransplant ECG of 3 months) revealed any new signs of right heart strain. Per literature review, 2 there does not appear to be a consensus on when and how often ECGs should be performed prior to liver transplant, but it appears serial ECGs would allow for closer monitoring of newly developing right heart strain or failure.Given the high mortality of this rare yet fatal disease, maximizing the yield of diagnostic testing is of utmost importance. One biomarker that may be of use is endothelin A1, which is a potent vasoconstrictor that has been reported to be upregulated in patients with PPHTN. 2 Although it may not be routinely measured, perhaps it may serve a role as an adjunctive measure in addition to serial ECGs to monitor for possible PPHTN development, both prior to and after liver transplant.Although posttransplant PPHTN is extremely rare, we advocate for the need for a standardized approach that combines both serial ECGs and endothelin A1 levels both prior to and after liver transplant to detect early development of PPHTN given the high mortality associated with this condition.

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Further Questions Regarding Electrocardiogram Prior to Liver Transplant—Reply

Littmann

¹

,

Potter

²

,

Hoglund

³

2018

JAMA Intern Med

0

View full text Add to dashboard Cite

To the Editor We read with great interest the Challenges in Clinical Electrocardiography by Littman et al 1 published in a recent issue of JAMA Internal Medicine. The authors present the electrocardiogram (ECG) as a simple and inexpensive, yet powerful, tool for the early detection of portopulmonary hypertension (PPHTN). This case is very unique in that the development of PPHTN was very rapid and occurred after successful liver transplant. Various studies 2 have noted that the prevalence of PPHTN is 1% to 2% among patients with portal hypertension but increases to 5% to 8% in candidates for transplant. 2 Even so, given that PPHTN occurs 4 to 7 years after patients are diagnosed with portal hypertension, 3 the rapid progression of disease is interesting in the absence of what appears to be predisposing factors. One would imagine that successful liver transplant would have prevented this conversion from occurring, especially without any documented clinical evidence of portal hypertension.As Littman et al 1 have noted, we agree that the use of ECG is a simple, inexpensive, and powerful tool in the early detection of PPHTN. However, although a pretransplant ECG was noted to be normal, it is difficult to assess when this ECG was performed and whether any ECGs that may have been performed afterwards (prior to the posttransplant ECG of 3 months) revealed any new signs of right heart strain. Per literature review, 2 there does not appear to be a consensus on when and how often ECGs should be performed prior to liver transplant, but it appears serial ECGs would allow for closer monitoring of newly developing right heart strain or failure.Given the high mortality of this rare yet fatal disease, maximizing the yield of diagnostic testing is of utmost importance. One biomarker that may be of use is endothelin A1, which is a potent vasoconstrictor that has been reported to be upregulated in patients with PPHTN. 2 Although it may not be routinely measured, perhaps it may serve a role as an adjunctive measure in addition to serial ECGs to monitor for possible PPHTN development, both prior to and after liver transplant.Although posttransplant PPHTN is extremely rare, we advocate for the need for a standardized approach that combines both serial ECGs and endothelin A1 levels both prior to and after liver transplant to detect early development of PPHTN given the high mortality associated with this condition.

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Cited by 8 publications

References 62 publications

Atualização no Tratamento da Hipertensão Arterial Pulmonar

Atualização no Tratamento da Hipertensão Arterial Pulmonar

Further Questions Regarding Electrocardiogram Prior to Liver Transplant

Further Questions Regarding Electrocardiogram Prior to Liver Transplant—Reply

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