Hypoxic Pulmonary Vasoconstriction in Liver Cirrhosis

Naeije, Robert; Hallemans, Roger; Mols, Pierre; Mélot, Christian

doi:10.1378/chest.80.5.570

Cited by 57 publications

(25 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A decrease in hypoxic pulmonary vasoconstriction was found by NAEIJE et al [9,10] and MELOT et al [11] in approximately 30% of patients with advanced cirrhosis. In a study by RODRIGUEZ-ROISIN et al [7], the group of cirrhotic patients with more severe liver failure had lower systemic and pulmonary vascular resistances, as well as less pulmonary vasoconstriction in response to hypoxia.…”

Section: Haemodynamics In Cirrhosis With Portal Hypertensionmentioning

confidence: 78%

“…Mild arterial hypoxaemia is due to ventilation/perfusion mismatching characterized by an increase in perfusion while ventilation is preserved. Impaired hypoxic vasoconstriction and increased pulmonary blood flow may contribute to these ventilation/perfusion abnormalities [7,9,10]. In the most severe cases, major intrapulmonary shunting and diffusion limitation may coexist [63,64] as a result of the intrapulmonary vascular dilatations.…”

Section: Mechanism Of Hypoxaemiamentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary vascular disorders in portal hypertension

Hervé

Lebrec²,

Brénot³

et al. 1998

Eur Respir J

328

239

View full text Add to dashboard Cite

aaThis review focuses on the pulmonary vascular complications of chronic liver failure and portal hypertension. The wide spectrum of pulmonary vascular disorders in liver disease and portal hypertension ranges from the hepatopulmonary syndrome (HPS), which is characterized by intrapulmonary vascular dilatations, to pulmonary hypertension (portopulmonary hypertension), in which pulmonary vascular resistance (PVR) is elevated. The exact pathophysiological mechanisms of these pulmonary vascular disorders are unknown. However, since HPS and portopulmonary hypertension have been reported in patients with nonhepatic portal hypertension, the factor that determines their development must be portal hypertension.A brief review of the haemodynamic changes observed in cirrhosis with portal hypertension is summarized, and the clinical and experimental evidence suggesting that the liver exerts a critical influence on the regulation of pulmonary vascular tone and angiogenesis is described. Portopulmonary hypertension is then discussed, focusing in turn on its clinical presentations, management and potential mechanisms, and referring to our findings in 39 patients with portopulmonary hypertension and 140 patients with primary pulmonary hypertension (PPH) admitted between 1986 and 1996 at Antoine Béclère Hospital. Finally, HPS will be examined, with a discussion of the mechanisms of hypoxaemia and intrapulmonary vascular dilatation, as well as its clinical presentation, diagnosis and treatment, with special attention to liver transplantation. Haemodynamics in cirrhosis with portal hypertensionAn understanding of pulmonary haemodynamics in liver disease with portal hypertension is important to a study of the pulmonary vascular disorders seen in this setting. A hyperdynamic circulatory state with high cardiac output, low systemic vascular resistance and low PVR is present in 30-50% of patients with cirrhosis and also in animal models of portal hypertension [1][2][3][4]. Compared with healthy subjects ( fig. 1) The wide spectrum of pulmonary vascular disorders in liver disease and portal hypertension ranges from the hepatopulmonary syndrome characterized by intrapulmonary vascular dilatations, to pulmonary hypertension (portopulmonary hypertension), in which pulmonary vascular resistance is elevated. Since hepatopulmonary syndrome and portopulmonary hypertension have been reported in patients with nonhepatic portal hypertension, the common factor that determines their development must be portal hypertension. The clinical presentations are very different, with gas exchange impairment in the hepatopulmonary syndrome and haemodynamic failure in portopulmonary hypertension. The severity of hepatopulmonary syndrome seems to parallel the severity of liver failure, whereas no simple relationship has been identified between hepatic impairment and the severity of portopulmonary hypertension. Resolution of hepatopulmonary syndrome is common after liver transplantation, which has an uncertain effect in portopulmonary hypertension. The pathoph...

show abstract

Section: Haemodynamics In Cirrhosis With Portal Hypertensionmentioning

confidence: 78%

Section: Mechanism Of Hypoxaemiamentioning

confidence: 99%

Pulmonary vascular disorders in portal hypertension

Hervé

Lebrec²,

Brénot³

et al. 1998

Eur Respir J

328

239

View full text Add to dashboard Cite

show abstract

“…Systemic and pulmonary vasodilatation in cirrhosis and portal hypertension appears to be the consequence of a widespread decrease in vascular tone [92,93] that results in impaired responsiveness to vasoconstrictors [94,95]. Hypoxic pulmonary vasoconstriction is absent or mitigated iny30% of patients with advanced cirrhosis, with or without associated HPS, and appears to become less evident as liver disease worsens [33,34,[96][97][98]. Whether or not a progressive loss of pulmonary vascular tone as liver disease deteriorates contributes to IPVD and the development of HPS remains controversial [22,98,99].…”

Section: Clinical Diagnosismentioning

confidence: 99%

Pulmonary-Hepatic vascular Disorders (PHD)

Rodríguez-Roisín

Krowka

Hervé

et al. 2004

European Respiratory Journal

707

600

View full text Add to dashboard Cite

“…These pathological pulmonary conditions in patients with cirrhosis have been well documented in the absence of other intrinsic cardiac and pulmonary diseases. [1][2][3][4][5][6][7] Between 30% to 70% of the patients with cirrhosis are reportedly hypoxemic; 0.25% to 12.5% of the patients with advanced liver disease have clinical evidence of pulmonary hypertension, with higher percentages reported in studies using right cardiac catheterization. 1,4,[6][7][8][9][10] The natural history of this association between portal hypertension and pulmonary dysfunction in patients with cirrhosis, possible mechanisms, and implications for liver transplantation are not well understood.…”

mentioning

confidence: 99%

Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation

et al. 1999

View full text Add to dashboard Cite

Cirrhosis and portal hypertension may be associated with pulmonary hypertension and pulmonary dysfunction. However, morphological pulmonary vascular lesions in patients with cirrhosis have not been well characterized morphometrically. We morphometrically evaluated pulmonary vessels in liver transplant recipients with pretransplantation cirrhosis and correlated our findings with pretransplantation cardiopulmonary function, postoperative course, and postmortem cardiopulmonary findings. Autopsy lung slides from 23 transplant recipients with pretransplantation cirrhosis were examined. External vessel diameter, intimal thickness, and arterial medial thickness were measured with a micrometer after pentachrome staining. The percent of total diameter comprised by intima or media was calculated for each vessel. Medical records were reviewed for smoking history, pretransplantation cardiopulmonary function testing, and postoperative course. Autopsy cases without liver or significant cardiopulmonary diseases, matched for age, sex, and smoking history, served as controls. Transplant recipients had significantly more pulmonary venous intimal thickening than matched controls (P F .0001). Sixty-five percent (15 of 23) of these patients had some degree of pretransplantation pulmonary dysfunction, defined by abnormalities in pulmonary function tests, oxygen saturation, and/or increased pulmonary artery pressures. However, the severity of venous intimal thickening did not correlate with the severity of pretransplantation pulmonary dysfunction. Arterial intimal and medial thickness were not statistically significantly different from controls. Pulmonary venous intimal thickening and resultant luminal impingement are morphological findings not previously described in this population. The arterial lesion, when present, is similar to that seen in pulmonary hypertension from other causes. These pulmonary vascular lesions may be implicated in pulmonary dysfunction in patients with cirrhosis and may be associated with increased posttransplantation cardiopulmonary morbidity and mortality. Copyright 1999 by the American Association for the Study of Liver Diseases S evere chronic liver disease, especially cirrhosis with concomitant portal hypertension, has been associated with numerous pulmonary abnormalities, including hypoxemia, decreased diffusion capacity, intrapulmonary and portopulmonary shunting, ventilation/perfusion mismatch, pleural vascular anomalies, and pulmonary hypertension. These pathological pulmonary conditions in patients with cirrhosis have been well documented in the absence of other intrinsic cardiac and pulmonary diseases. 1-7 Between 30% to 70% of the patients with cirrhosis are reportedly hypoxemic; 0.25% to 12.5% of the patients with advanced liver disease have clinical evidence of pulmonary hypertension, with higher percentages reported in studies using right cardiac catheterization. 1,4,[6][7][8][9][10] The natural history of this association between portal hypertension and pulmonary dysfunction in patients with c...

show abstract

Hypoxic Pulmonary Vasoconstriction in Liver Cirrhosis

Cited by 57 publications

References 15 publications

Pulmonary vascular disorders in portal hypertension

Pulmonary vascular disorders in portal hypertension

Pulmonary-Hepatic vascular Disorders (PHD)

Pulmonary vascular morphological changes in cirrhotic patients undergoing liver transplantation

Contact Info

Product

Resources

About