Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of an Intrapulmonary Shunt in Liver Disease

Védrinne, J; Duperret, S.; Bizollon, T.; Magnin, C.; Motin, J; Trépo, C.; Ducerf, C.

doi:10.1378/chest.111.5.1236

Cited by 139 publications

(82 citation statements)

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“…Although long recognized clinically, the pathogenic defects underlying arterial hypoxemia in cirrhosis remain unclear despite many proposed mechanisms. As a syndrome, HPS has been described formally both clinically 4 and radiographically, 5 so that practically measurable parameters can be readily evaluated to assess patients with advanced liver disease for manifestation of HPS. Demonstration of the triad of advanced liver disease, hypoxemia, and pulmonary vasodilation is most often employed to diagnose HPS.…”

Section: Discussionmentioning

confidence: 99%

“…Resolution of oxygen dependency occurred in all patients but was delayed in the two patients exhibiting complicating pulmonary hypertension (288. 5 P atients with chronic advanced liver disease frequently show abnormalities in numerous organs. For example, renal insufficiency (hepatorenal syndrome) and peripheral arteriovenous shunting are widely recognized sequelae of cirrhosis.…”

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confidence: 99%

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Retrospective analysis of the results of liver transplantation for adults with severe hepatopulmonary syndrome

Collisson

Nourmand

Fraiman

et al. 2002

Liver Transplantation

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The hepatopulmonary syndrome (HPS), consisting of elevated alveolar-arterial oxygen gradient and intrapulmonary vascular abnormalities in the presence of advanced liver disease, is associated with high mortality. Liver transplantation (LT) has been used for the treatment of HPS; however, the success of LT for the treatment of HPS is not uniformly documented. We reviewed our experience over a 5-year period and identified eight adult patients with incapacitating respiratory symptoms compatible with HPS. Inclusion criteria included hypoxemia, normal lung volumes, reduced oxygen diffusing capacity (D L CO), and the presence of intrapulmonary shunting. Underlying liver disease was caused by hepatitis C (2 patients), primary biliary cirrhosis (1 patient), cryptogenic cirrhosis (1 patient), alcohol (2 patients), and hepatitis C with alcohol P atients with chronic advanced liver disease frequently show abnormalities in numerous organs. For example, renal insufficiency (hepatorenal syndrome) and peripheral arteriovenous shunting are widely recognized sequelae of cirrhosis. Less often recognized are the defects in pulmonary gas exchange observed with liver disease. A hepatopulmonary syndrome (HPS) has been described and encompasses a specific group of patients with severe liver disease and without cardiorespiratory disease who develop impaired gas exchange because of intrapulmonary vasodilatation (IPVD).In the past, hypoxemia was considered an absolute contraindication to liver transplantation (LT) 1 because of the operative and perioperative complications that arise in patients with gas exchange abnormalities. As the recognition of and experience with HPS has increased, concepts regarding indications LT for transplantation have come full circle, and it has been suggested that, in the face of otherwise stable liver disease, symptomatic HPS in and of itself may constitute an indication for LT. The role for transplantation in HPS is supported by the observation that the metabolic defects responsible for the pulmonary manifestations of HPS clearly are hepatic in origin, progressive, and, at present, refractory to medical management. However, the success of LT for the treatment of HPS is not uniformly documented.In the current study, we reviewed our single-center experience of eight patients with diagnosed HPS evaluated for LT, and report their long-term outcome and complications. Experimental Procedures Preoperative EvaluationAll patients were referred to UCLA for liver transplantation (LT) routinely undergo pulmonary function

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Retrospective analysis of the results of liver transplantation for adults with severe hepatopulmonary syndrome

Collisson

Nourmand

Fraiman

et al. 2002

Liver Transplantation

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“…Intracardiac communication was considered to be present when the contrast was observed in the left atrium for three cardiac cycles following the opacification of the right atrium. (19) In order to diagnose HPS, we used a criterion that is currently recommended by guidelines published in 2004; the criterion consists of identifying IPVD through TTE, together with changes in arterial blood gases, which were defined as an A-aDO 2 ≥ 15 mmHg or a PaO 2 < 80 mmHg (both adjusted for age).…”

Section: Resultsmentioning

confidence: 99%

Ocorrência de síndrome hepatopulmonar em pacientes cirróticos candidatos a transplante de fígado

et al. 2010

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Objective: To determine the occurrence of hepatopulmonary syndrome (HPS) in patients with cirrhosis who are candidates for liver transplantation; to compare demographic, clinical, laboratory, and spirometric characteristics, as well as echocardiography results, arterial blood gas analysis, and severity of liver disease between the groups of patients with and without HPS; and to describe the occurrence of HPS in the subgroup of patients with cirrhosis and schistosomiasis mansoni (mixed liver disease). Methods: Between January and November of 2007, we evaluated 44 patients under treatment at the Liver Transplant Outpatient Clinic of the Federal University of Pernambuco Hospital das Clínicas, in the city of Recife, Brazil. The diagnostic criteria for HPS were intrapulmonary vascular dilatation, identified by transthoracic echocardiography, and an alveolar-arterial oxygen tension difference ≥ 15 mmHg or a PaO 2 < 80 mmHg. Results: The mean age of the patients was 52 years, and 31 patients (70%) were males. The most common cause of cirrhosis was alcohol use. Schistosomiasis was present in 28 patients (64%). Of the 44 patients, 20 (45.5%) were diagnosed with HPS. No significant differences were found between those patients and the patients without HPS in terms of any of the characteristics studied. Of the 28 patients with cirrhosis and schistosomiasis, 10 (35.7%) were diagnosed with HPS. Conclusions: In the population studied, HPS was highly prevalent and did not correlate with any of the variables analyzed.Keywords: Hepatopulmonary syndrome; Liver transplantation; Liver cirrhosis; Hypertension, portal; Schistosomiasis mansoni; Echocardiography. ResumoObjetivo: Verificar a ocorrência da síndrome hepatopulmonar (SHP) em pacientes cirróticos candidatos a transplante de fígado; comparar as características demográficas, clínicas, laboratoriais e espirométricas, resultados de ecocardiografia, análise de gases arteriais e da gravidade da doença hepática nos pacientes com e sem SHP; e descrever a ocorrência de SHP no subgrupo de pacientes com cirrose associada à esquistossomose mansônica (doença hepática mista). Métodos: Entre janeiro e novembro de 2007, foram avaliados 44 pacientes inscritos no Ambulatório de Transplante Hepático do Hospital das Clínicas da Universidade Federal de Pernambuco, em Recife (PE). Os critérios diagnósticos para SHP foram a presença de dilatações vasculares intrapulmonares, identificadas por ecocardiografia transtorácica, assim como diferença alveoloarterial de oxigênio ≥ 15 mmHg ou PaO 2 < 80 mmHg. Resultados: A idade média foi 52 anos, e 31 pacientes (70%) eram do sexo masculino. A causa mais frequente de cirrose foi uso de etanol. A esquistossomose esteve presente em 28 pacientes (64%). Dos 44 pacientes, 20 (45,5%) foram diagnosticados com SHP. Não foram observadas diferenças significativas em relação às características estudadas. No subgrupo de pacientes com cirrose associada à esquistossomose, 10/28 (35,7%) receberam o diagnóstico de SHP. Conclusões: A SHP apresentou elevada prevalênc...

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“…Such communication is considered present if the contrast reaches the left atrium by the third cycle. 64,69,70 In normal situations, the contrast particles, which vary in diameter depending on the type of contrast used, are impacted in pulmonary capillaries of normal diameter. They are then physiologically absorbed by the alveoli and do not appear in the left atrium.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

“…69 Different results have been obtained in studies using these methods on cirrhotic candidates for liver transplantation. While some authors stress the superiority of TEE, which avoids the false positives encountered in TTE, 70,71 one study has stressed the greater efficacy and sensitivity of TTE over TEE, suggesting that the latter should used only in cases of negative TTE. 72 However, these differences are probably due to differences in image quality, which is better when images are taken at the second harmonic frequency rather than at the fundamental frequency.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

Hepatopulmonary syndrome: an update

Macedo

Lopes

2009

Sao Paulo Med. J.

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Hepatopulmonary syndrome (HPS) is a clinical threesome composed of liver disease, intrapulmonary vascular dilatation (IPVD) and arterial gas abnormalities. Its occurrence has been described in up to 32% of cirrhotic candidates for liver transplantation. It also affects non-cirrhotic patients with portal hypertension. Its pathogenesis is not well defined, but an association of factors such as imbalance in the endothelin receptor response, pulmonary microvascular remodeling and genetic predisposition is thought to lead to IPVD. Diagnosis is based on imaging methods that identify these dilatations, such as contrast echocardiography or perfusion scintigraphy with RESUMOA síndrome hepatopulmonar (SHP) é considerada uma tríade clínica composta de doença hepática, dilatações vasculares intrapulmonares (IPVD) e alterações de gases arteriais. Há descrição de sua ocorrência em até 32% dos cirróticos candidatos ao transplante de fígado, acometendo também não cirróticos com hipertensão portal. Sua etiopatogenia não está bem definida, mas se especula que a associação de fatores como o desequilíbrio na resposta dos receptores vasculares de endotelina, o remodelamento microvascular pulmonar e a predisposição genética propiciem as IPVD. O diagnóstico baseia-se em métodos de imagem que identifiquem essas dilatações, como a ecocardiografia com contraste ou a cintilografia de perfusão com 99m Tc, além da análise de gases arteriais, para identificar elevação da diferença alvéolo-arterial de O 2 ou hipoxemia. Não existe tratamento medicamentoso eficaz e sua resolução completa ocorre apenas com o transplante de fígado. A importância do diagnóstico da SHP está em priorizar os candidatos ao transplante, uma vez que sua presença está associada ao pior prognóstico. O objetivo deste artigo é fazer revisão das teorias de etiopatogenia da

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Comparison of Transesophageal and Transthoracic Contrast Echocardiography for Detection of an Intrapulmonary Shunt in Liver Disease

Cited by 139 publications

References 13 publications

Retrospective analysis of the results of liver transplantation for adults with severe hepatopulmonary syndrome

Retrospective analysis of the results of liver transplantation for adults with severe hepatopulmonary syndrome

Ocorrência de síndrome hepatopulmonar em pacientes cirróticos candidatos a transplante de fígado

Hepatopulmonary syndrome: an update

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