The Demonstration of Porta-Pulmonary Anastomoses in Portal Cirrhosis with the Use of Radioactive Krypton (Kr⁸⁵)

The Frequency and Significance of Portopulmonary Venous Anastomosis (PPVA): A Case Report and Literature Review

“…The previously published case series and case reports provide no solid evidence that PPVA causes hypoxia. Time and experience has supported Shaldon's [12] theoretical case against PPVA causing hypoxia. Their final opinion was that a PPVA in a patient with cirrhosis and portal hypertension does not cause hypoxia, cyanosis, or clubbing.…”

“…Eight articles [3,[6][7][8][9][10][11][12] were relevant to this "frequency" question. Each of these articles describes a series of subjects with cirrhosis who were investigated with a technique capable of proving the presence or absence of a PPVA (Table 1).…”

“…In 1961 investigators used intrasplenic injection of radioactive krypton 85 to identify a PPVA in 1 of 12 (8%) subjects with cirrhosis [12]. Solubilized radioactive krypton gas is removed from the blood during one pass through the lungs.…”

“…The study of Shaldon et al [12] was performed to see if PPVA could explain the varying degree of finger clubbing and hypoxia seen in 12 patients with cirrhosis. They demonstrated the presence of a PPVA shunt in one out of the 12 patients.…”

Sources of Venoarterial Admixture in Portal Hypertension*

“…Shaldon and colleagues (27) in 12 patients compared the arterial concentrations of krypton85 in samples drawn during the first minute after iv injection and injection into the spleen of the same amount of krypton85. They found in 11 patients lower concentrations in arterial blood after injections into the spleen, but one patient showed a fourfold increase of the concentration of krypton85 after injection into the spleen relative to that resulting from iv injection.…”