A ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares em candidatos ao transplante hepático

Pavarino, Paulo Roberto; Corbucci, Hélio Augusto dos Reis; Marchi, Carlos Henrique; Mata, Paula Fernanda da; Godoy, Moacir Fernandes de

doi:10.1590/s0066-782x2004000600004

Cited by 4 publications

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“…(19) In the present study, the TTE results were suggestive of IPVD in 52% of the patients, which is in accordance with the results of other studies, in which rates ranging from 30 to 56% were reported. (4,(25)(26)(27) It is of note that, in the present study, the waiting time for transplantation was long (mean, 27 months). This is similar to that reported for other liver transplant centers before the MELD score came into use as a means of determining the position on the waiting list.…”

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confidence: 55%

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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Section: Discussionmentioning

confidence: 55%

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

et al. 2010

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“…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. 73,74 There is one report in which higher occurrence of IPVD in comparison to findings from other studies [72][73][74][75] was attributed to better resolution of the TTE images at the second harmonic.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

“…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. 73,74 There is one report in which higher occurrence of IPVD in comparison to findings from other studies [72][73][74][75] was attributed to better resolution of the TTE images at the second harmonic. 76 The sensitivity of TTE for diagnosing IPVD is currently questioned less than its capacity to rule out false-positive results, such as cases of patent foramen ovale.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

“…77 Although echocardiography is better than 99m TcMAA, there may be false-positive results with the TTE technique, depending on the echocardiographic technique used. 72,74 In fact, studies that have evaluated the TTE technique, taking the TEE as the gold standard, have described sensitivity of 68% to 75% and specificity of 93% to 100% for TTE. 72,74 In addition, there is evidence in the literature that TTE with contrast is as accurate as TEE with contrast for determining the presence of right-to-left shunt.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

“…72,74 In fact, studies that have evaluated the TTE technique, taking the TEE as the gold standard, have described sensitivity of 68% to 75% and specificity of 93% to 100% for TTE. 72,74 In addition, there is evidence in the literature that TTE with contrast is as accurate as TEE with contrast for determining the presence of right-to-left shunt. However, further studies are needed to describe the equivalence between these two techniques, in order to determine the source of the right-to-left shunt.…”

Section: Diagnosing Of Ipvdmentioning

confidence: 99%

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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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Hepatopulmonary syndrome in patients with Schistosoma mansoni periportal fibrosis

et al. 2009

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A ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares em candidatos ao transplante hepático

Cited by 4 publications

References 24 publications

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

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

Hepatopulmonary syndrome: an update

Hepatopulmonary syndrome in patients with Schistosoma mansoni periportal fibrosis

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