Portopulmonary hypertension: Results from a 10-year screening algorithm

Abstract

Portopulmonary hypertension (POPH) is the elevation of pulmonary artery pressure due to increased resistance to pulmonary blood flow in the setting of portal hypertension. Increased mortality has occurred with attempted liver transplantation in such patients and thus, screening for POPH is advised. We examined the relationship between screening echocardiography and right heart catheterization determinations of pressure, flow, volume, and resistance. A prospective, echocardiography-catheterization algorithm was followed from P ulmonary hypertension associated with advanced liver disease has variable etiologies and prognostic implication. [1][2][3][4] First, the hyperdynamic, high-flow circulatory state (as a consequence of splanchnic vasodilatation caused by portal hypertension) results in high cardiac output (CO) and an increase in mean pulmonary artery pressure (MPAP), but the pulmonary vascular resistance (PVR) remains normal. Second, elevated MPAP with increased central blood volume estimate as measured by the pulmonary arterial occlusion pressure (PAOP) results in variable effect on PVR. Third, for reasons yet to be characterized, and regardless of liver disease severity, additional hemodynamic change can occur due to development of pulmonary artery endothelial/smooth muscle proliferation, vasoconstriction, in situ thrombosis, and plexogenic arteriopathy. Such pathology results in progressive obstruction to pulmonary arterial flow from the right ventricle to the lungs, very high pulmonary artery

The polycompartment syndrome: a concise state-of-the-art review

“…lymphocytic interstitial pneumonia, fibrosing alveolitis, COP, or noncardiogenic pulmonary oedema from fluid overload or hepato-abdominal-renal syndrome), or vascular (e.g. alveolar haemorrhage, hepatopulmonary syndrome or portopulmonary hypertension) [139].…”

Untitled

“…However, it should be noted that increases in both TPG and PCWP do not exclude a diagnosis of POPH. 14 The pathogenesis of POPH is not completely understood. It has been proposed that prolonged pulmonary vasoconstriction results in vascular remodeling of the pulmonary vascular bed.…”

Anesthesia for a Patient with Severe Pulmonary Hypertension Undergoing Laparoscopic Cholecystectomy: A Case Report

“…Intraoperative propofol 120 mg/h and remifentanil 0.4 mg/h intravenously maintenance durning the operation. Since the surgery start, the airway pressure was about 22 cm H 2 O.The signs were stability during the operation: the blood pressure remained at about 105/65 mmHg, the heart rate remained at about 55 times per minute, the criteria in WHO for the definition of pulmonary hypertension (PH) is the pulmonary systolic pressure >40 mmHg [2]. It is generally believed that pulmonary arterial pressure (PAP) ≥ 25 mmHg at rest as assessed by right heart catheterization [3][4][5].When the pulmonary artery pressure is between 30 and 49 mmHg, it is mildly; between 50 and 79 mmHg means moderate and ≥ 80 mmHg is described as severe [6,7].…”