Portopulmonary hypertension: A focused review for the internist

Chhabria, Mamta S.; Boppana, Leela Krishna Teja; Manek, Gaurav; Tonelli, Adriano R.

doi:10.3949/ccjm.90a.23023

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…У пацієнтів із захворюваннями печінки існують три види порушення гемодинаміки окремо або у поєднанні [15]:…”

Section: класифікація і гемодинамічні особливостіunclassified

Portopulmonary hypertension: peculiarities of diagnosis and treatment

Chooklin,

Chuklin,

Posivnych

et al. 2024

ЕМ

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Portopulmonary hypertension is defined as the development of pulmonary hypertension secondary to portal one. Its exact prevalence is difficult to determine due to the lack of routine screening in patients with portal hypertension. Hemodynamic changes associated with portal hypertension, including the hyperdynamic state, portosystemic shunts, and splanchnic vasodilation, cause significant disturbances in the pulmonary vasculature and play a key role in the pathogenesis of the disease. Without treatment, portopulmonary hypertension leads to progressive right ventricular failure with a poor prognosis. Although Doppler echocardiography is the best initial screening tool for symptomatic patients and candidates for liver transplant, right heart catheterization remains the gold standard for disease diagnosis. Treatment of patients with portopulmonary hypertension is aimed at improving cardiac function, reducing pulmonary vascular resistance, and optimizing functional capacity. Pulmonary hypertension-specific therapy, which includes prostacyclin and its receptor agonists, endothelin receptor antagonists, phosphodiesterase inhibitors, and guanylate cyclase stimulators, plays a key role in the treatment of patients with portopulmonary hypertension. Small uncontrolled and recent single randomized controlled trials have reported promising results of vasodilator therapy in terms of clinical and hemodynamic improvement in patients, allowing certain patients to undergo liver transplantation. This review discusses the epidemiology, approach to diagnosis and treatment of patients with portopulmonary hypertension. We used MEDLINE database on the PubMed platform and the Cochrane library to search for literature sources using the keywords: portopulmonary hypertension, portal hypertension, pulmonary hypertension, liver cirrhosis, pulmonary complications.

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Section: класифікація і гемодинамічні особливостіunclassified

Portopulmonary hypertension: peculiarities of diagnosis and treatment

Chooklin,

Chuklin,

Posivnych

et al. 2024

ЕМ

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Trends in Transcatheter Aortic Valve Implantation Utilization, Outcomes, and Healthcare Resource Use in Patients With Liver Cirrhosis: A Decade of Insights (2011–2020)

Krittanawong,

Wang,

Qadeer

et al. 2024

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine

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It is well known that individuals with liver cirrhosis are considered at high risk for cardiac surgery, with an increased risk for morbidity and mortality as the liver disease progresses. In the last decade, there have been considerable advances in transcatheter aortic valve implantation (TAVI) as an alternative to surgical aortic valve replacement (SAVR) in individuals deemed to be at high risk for surgery. However, research surrounding TAVI in the setting of liver cirrhosis has not been as widely studied. In this national population-based cohort study, we evaluated the trends of mortality, complications, and healthcare utilization in liver cirrhotic patients undergoing TAVI, as well as analyzed the basic demographics of these individuals. We found that from 2011 to 2020, the amount of TAVI procedures conducted in cirrhotic patients was increasing annually, while mortality, procedural complications, and healthcare utilization trends in these cirrhotic patients undergoing TAVI decreased. Overall, TAVI does seem to be reasonable management for aortic stenosis patients with liver cirrhosis who need aortic valve replacement.

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Clinical Implications and Management of Spontaneous Portosystemic Shunts in Liver Cirrhosis

Juncu,

Minea,

Girleanu

et al. 2024

Diagnostics

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Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes current knowledge on SPSS, covering their clinical impact and management strategies. Recent data suggest that SPSS increases the risk of variceal bleeding, regardless of shunt size. The size of the shunt is crucial in the rising incidence of hepatic encephalopathy (HE) linked to SPSS. It also increases the risk of portopulmonary hypertension and portal vein thrombosis. Detecting and assessing SPSS rely on computed tomography (CT) and magnetic resonance imaging. CT enables precise measurements and the prediction of cirrhosis progression. Management focuses on liver disease progression and SPSS-related complications, like HE, variceal bleeding, and portopulmonary hypertension. Interventional radiology techniques such as balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration play a pivotal role. Surgical options are rare but are considered when other methods fail. Liver transplantation (LT) often resolves SPSS. Intraoperative SPSS ligation is still recommended in patients at high risk for developing HE or graft hypoperfusion.

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Portopulmonary hypertension: A focused review for the internist

Cited by 3 publications

References 42 publications

Portopulmonary hypertension: peculiarities of diagnosis and treatment

Portopulmonary hypertension: peculiarities of diagnosis and treatment

Trends in Transcatheter Aortic Valve Implantation Utilization, Outcomes, and Healthcare Resource Use in Patients With Liver Cirrhosis: A Decade of Insights (2011–2020)

Clinical Implications and Management of Spontaneous Portosystemic Shunts in Liver Cirrhosis

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