Left Atrial Volume: A Novel Predictor of Hepatopulmonary Syndrome

Zamirian, Mahmood; Aslani, Amir; Shahrzad, Shahab

doi:10.1111/j.1572-0241.2007.01228.x

Cited by 32 publications

(25 citation statements)

References 32 publications

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“…Consistent with the decreased diffusion capacity of oxygen observed in HPS, the diffusing capacity of the lung for carbon monoxide can be found to be low. The hyperdynamic circulation of cirrhosis can also arise in left atrial enlargement in the absence of any specific cardiac disease [78], although this has not been observed in all studies [64,65]. Inclusively, right-sided cardiac dilatation was observed in one study [65].…”

Section: Diagnostic Evaluation and Classificationmentioning

confidence: 86%

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Altamirano²,

et al. 2012

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Liver disease and portal hypertension can be associated with pulmonary vascular complications, including portopulmonary hypertension (POPH), characterised by an elevated mean pulmonary artery pressure secondary to an increased pulmonary vascular resistance, and hepatopulmonary syndrome (HPS), characterised by hypoxaemia due to pulmonary vasodilatation and shunting.Although clear diagnostic guidelines exist for both conditions on the basis of echocardiography, right heart catheterisation and arterial blood gases, there is considerable variation between centres regarding diagnosis and management of these conditions. Awareness of evaluation and management algorithms for POPH and HPS are critical for optimisation of outcomes in patients with these conditions. Key aspects of management of POPH and HPS include identification of patients likely to benefit from liver transplantation (LTx) and management before and after LTx. Although both disorders may improve after LTx, severe forms of POPH represent a contraindication to LTx.Novel approaches to the treatment of POPH and HPS offer new management options that may expand the pool of transplantable patients and improve overall outcomes.

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Section: Diagnostic Evaluation and Classificationmentioning

confidence: 86%

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Altamirano²,

et al. 2012

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“…In our study, circulating measures of the NO-cGMP cascade were not increased, but rather decreased, in the IPVS patients. A recent study reported that left atrial volume is a novel predictor of hepatopulmonary syndrome (12). In accordance with these findings we found that BNP was elevated in those children with IVPS.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Vascular Complications in Asymptomatic Children With Portal Hypertension

Whitworth

Ivy

Gralla

et al. 2009

J. pediatr. gastroenterol. nutr.

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Objectives To determine the prevalence of Portopulmonary Hypertension (PPHTN), Hepatopulmonary Syndrome (HPS), and Intrapulmonary Vascular Shunting (IPVS) in children with clinically stable portal hypertension and to assess the value of vasoactive peptide levels, biochemical tests and clinical signs or symptoms to predict these conditions. Methods A prospective, cross-sectional analysis was conducted on 33 children, ages 4 to 17 years, with stable cirrhosis (n=28) or extrahepatic portal hypertension (n=5). The children were screened for IPVS and hypoxia with contrast-enhanced echocardiography (cECHO) and pulse oximetry, and screened for pulmonary hypertension with Doppler echocardiography. Chemistries, x-rays, physical examinations and levels of vasoactive peptides were compared between subjects with IPVS and those with normal cECHO. Results No subject had pulmonary hypertension. Six (19%) had IPVS, all of which had intrahepatic causes of portal hypertension, and one of whom had HPS. Compared to subjects with normal cECHO, those with IPVS had biochemical evidence of more advanced liver disease and higher b-type natriuretic peptide (BNP) levels. Conclusions PPHTN and HPS appear to be rare in clinically stable children with portal hypertension. IPVS was present in 19% of these patients. A novel finding of this study is the elevation of BNP in children with IPVS.

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“…The acquired intrapulmonary shunt caused by cirrhosis is underappreciated but welldefined by the hepatopulmonary syndrome (HPS). A diagnosis of HPS can be established in the presence of chronic liver disease, increased alveolar-arterial gradient, intrapulmonary vascular dilatation, and absence of primary cardiac or pulmonary disease [3]. …”

Section: Discussionmentioning

confidence: 99%

Paradoxical Emboli Secondary to Hepatic Pathology: Common or Coincidental?

Gabikian

Walker

Chowdhary

et al. 2009

Case Reports in Medicine

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Paradoxical cerebral emboli from cardiac and pulmonary sources are well described in the peer-reviewed literature. We outline a case with a hepatic etiology and describe diagnostic and management options. Though this paper represents the first documentation of such, we believe that transpulmonary shunting with concurrent paradoxical cerebral microemboli is more prevalent than recognized. We introduce this case report to compel practitioners to consider paradoxical emboli in selected cirrhotic patients since it can often be difficult to elicit subtle neurologic changes on clinical examination of patients with end stage liver disease.

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Left Atrial Volume: A Novel Predictor of Hepatopulmonary Syndrome

Abstract: In the context of liver cirrhosis, LAV >/= 50 mL is a simple and feasible parameter to detect HPS.

Cited by 32 publications

References 32 publications

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Pulmonary Vascular Complications in Asymptomatic Children With Portal Hypertension

Paradoxical Emboli Secondary to Hepatic Pathology: Common or Coincidental?

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