Diagnosis and grading of intrapulmonary vascular dilatation in cirrhotic patients with contrast transesophageal echocardiography

Aller, R.; Moya, José Luís Medina; Moreira, V. F.; García‐Lledó, Alberto; Sanroman, A. L.; Paı́no, Carlos Luis; Boixeda, D

doi:10.1016/s0168-8278(99)80317-1

Cited by 30 publications

(25 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The unpredictable relationship between the degree of hypoxemia due to HPS, comorbid reasons for hypoxemia, and severity or change in severity of liver disease must be stressed. [14][15][16][17][18] Our case-control study supported the importance of HPS in considering the long-term survival in both posttransplantation and non-transplantation patients. Recent data regarding long-term survival after liver transplantation from the UNOS database reported 1-, 5-, and 8-year post-OLT survival (n ϭ 8,172) of 83.9%, 70.2%, and 61.9%, respectively.…”

Section: Discussionsupporting

confidence: 68%

Natural history of hepatopulmonary syndrome: Impact of liver transplantation

2005

View full text Add to dashboard Cite

H epatopulmonary syndrome (HPS) is a pulmonary vascular disorder characterized by the clinical triad of chronic liver disease, intrapulmonary vascular dilatations, and arterial hypoxemia. 1,2 Portal hypertension (with or without cirrhosis) is often present. 2,3 The intrapulmonary vascular dilatations are identified by transthoracic contrast echocardiography (qualitative) or radionuclide lung perfusion scanning with brain uptake to measure shunt fraction (quantitative). 2 The degree of arterial hypoxemia associated with HPS has an unpredictable correlation with the severity or cause of the underlying liver disease. [1][2][3] The mechanism by which portal hypertension results in pulmonary vascular dilatation is unknown but appears to involve local effects of increased nitric oxide. 4 Although orthotopic liver transplantation (OLT) has become the mainstay of therapy for HPS in many centers, few data exist that describe long-term survival. 1,5 Despite the well-documented resolution of HPS after OLT, 1,5,6 we were interested in the long-term clinical course of all patients with this syndrome since the inception of the liver transplantation program at Mayo Clinic Rochester in 1985. Our aims were to determine longterm survival in HPS versus case controls, assess the impact of OLT on survival, and document partial pressure of arterial oxygen (PaO 2 ) change pre-and post-OLT. TcMAA. From the Patients and Methods Patient

show abstract

Section: Discussionsupporting

confidence: 68%

Natural history of hepatopulmonary syndrome: Impact of liver transplantation

2005

View full text Add to dashboard Cite

show abstract

“…PB is the barometric pressure, PACO 2 is the alveolar PCO 2, assumed to be equal to PaCO 2 , and R is the respiratory quotient estimated to 0.80 (31). To diagnose HPS, a CEE was done by agitating a mixture of 9 ml of saline and 1 ml of blood in two 10-ml syringes connected through a three-way stopcock producing microbubbles as previously described (1). To detect microbubbles, we used an apical four-chamber view with a 3-MHz transducer (Acuson Sequoia 512, Mountain View, CA).…”

Section: Study Protocolmentioning

confidence: 99%

Reduced baroreflex sensitivity and pulmonary dysfunction in alcoholic cirrhosis: effect of hyperoxia

Möller

Iversen

Krag

et al. 2010

American Journal of Physiology-Gastrointestinal and Liver Physi

View full text Add to dashboard Cite

Patients with cirrhosis exhibit impaired regulation of the arterial blood pressure, reduced baroreflex sensitivity (BRS), and prolonged QT interval. In addition, a considerable number of patients have a pulmonary dysfunction with hypoxemia, impaired lung diffusing capacity (Dl(CO)), and presence of hepatopulmonary syndrome (HPS). BRS is reduced at exposure to chronic hypoxia such as during sojourn in high altitudes. In this study, we assessed the relation of BRS to pulmonary dysfunction and cardiovascular characteristics and the effects of hyperoxia. Forty-three patients with cirrhosis and 12 healthy matched controls underwent hemodynamic and pulmonary investigations. BRS was assessed by cross-spectral analysis of variabilities between blood pressure and heart rate time series. A 100% oxygen test was performed with the assessment of arterial oxygen tensions (Pa(O(2))) and alveolar-arterial oxygen gradient. Baseline BRS was significantly reduced in the cirrhotic patients compared with the controls (4.7 +/- 0.8 vs. 10.3 +/- 2.0 ms/mmHg; P < 0.001). The frequency-corrected QT interval was significantly prolonged in the cirrhotic patients (P < 0.05). There was no significant difference in BRS according to presence of HPS, Pa(O(2)), Dl(CO), or Child-Turcotte score, but BRS correlated with metabolic and hemodynamic characteristics. After 100% oxygen inhalation, BRS and the QT interval remained unchanged in the cirrhotic patients. In conclusion, BRS is significantly reduced in patients with cirrhosis compared with controls, but it is unrelated to the degree of pulmonary dysfunction and portal hypertension. Acute hyperoxia does not significantly revert the low BRS or the prolonged QT interval in cirrhosis.

show abstract

“…Thus there may be a gradual transition from minor pulmonary abnormalities to a full-blown hepatopulmo- nary syndrome. The present technique may prove useful for the study of these patients in greater detail, for instance in combination with other techniques such as contrast echocardiography, ventilation-perfusion isotope scintigraphies, and multiindicator inert gas studies (2,20,35). However, this is a topic for future investigations.…”

Section: Discussionmentioning

confidence: 96%

Detection of early central circulatory transits in patients with cirrhosis by gamma variate fit of indicator dilution profiles

Henriksen¹,

Möller²,

Fuglsang³

et al. 2005

American Journal of Physiology-Gastrointestinal and Liver Physi

View full text Add to dashboard Cite

Patients with cirrhosis have hyperdynamic circulation with abnormally distributed blood volume and widespread arteriovenous communications. We aimed to detect possible very early (i.e., before 4 s) and early (i.e., after 4 s) central circulatory transits and their potential influence on determination of central and arterial blood volume (CBV). Thirty-six cirrhotic patients and nineteen controls without liver disease undergoing hemodynamic catheterization were given central bolus injections of albumin with different labels. Exponential and gamma variate fits were applied to the indicator dilution curves, and the relations between flow, circulation times, and volumes were established according to kinetic principles. No significant very early central circulatory transits were identified. In contrast, early (i.e., 4 s to maximal) transits corresponding to a mean of 5.1% (vs. 0.8% in controls; P < 0.005) of cardiac output (equivalent to 0.36 vs. 0.05 l/min; P < 0.01) were found in cirrhotic patients. These early transits averaged 7.7 vs. 12.7 and 17.2 s of ordinary central transits of cirrhotic patients and controls, respectively (P < 0.001). Early transits were directly correlated to the alveolar-arterial oxygen difference in the cirrhotic patients (r = 0.46, P< 0.01) but not in controls (r = 0.04; not significant). There was good agreement between the CBV determined by the conventional indicator dilution method and that determined by separation of early and ordinary transits by the gamma variate fit method (1.51 vs. 1.53 liter; not significant). In conclusion, no very early central circulatory transits were identified in cirrhotic patients. A significant part of the cardiac output undergoes an early transit, probably through pulmonary shunts or areas with low ventilation-perfusion ratios in cirrhotic patients. Composite determination of CBV by the gamma variate fit method is in close agreement with established kinetic methods. The study provides further evidence of abnormal central circulation in cirrhosis.

show abstract

Diagnosis and grading of intrapulmonary vascular dilatation in cirrhotic patients with contrast transesophageal echocardiography

Cited by 30 publications

References 21 publications

Natural history of hepatopulmonary syndrome: Impact of liver transplantation

Natural history of hepatopulmonary syndrome: Impact of liver transplantation

Reduced baroreflex sensitivity and pulmonary dysfunction in alcoholic cirrhosis: effect of hyperoxia

Detection of early central circulatory transits in patients with cirrhosis by gamma variate fit of indicator dilution profiles

Contact Info

Product

Resources

About