Saline Contrast Echocardiography in Patients With Hepatopulmonary Syndrome Awaiting Liver Transplantation

Lenci, I.; Alvior, A.; Manzia, Tommaso Maria; Toti, Luca; Neuberger, James; Steeds, Richard P.

doi:10.1016/j.echo.2008.09.020

Cited by 40 publications

(41 citation statements)

References 27 publications

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“…Consistent with the decreased diffusion capacity of oxygen observed in HPS, the diffusing capacity of the lung for carbon monoxide can be found to be low. The hyperdynamic circulation of cirrhosis can also arise in left atrial enlargement in the absence of any specific cardiac disease [78], although this has not been observed in all studies [64,65]. Inclusively, right-sided cardiac dilatation was observed in one study [65].…”

Section: Diagnostic Evaluation and Classificationmentioning

confidence: 88%

“…HPS has been reported in 10-30% of patients referred for LTx evaluation [60,61], but in only 1% of patients with chronic liver disease in the non-transplant setting [62]. The presence of either intrapulmonary shunts or oxygenation abnormalities are more common, occurring in 25-65% of patients awaiting LTx and in 5% of patients in the non-transplant setting [61][62][63][64]. HPS is usually diagnosed during the sixth decade of life and there is no specific association with sex or aetiology of liver disease.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

“…However, CE-TEE is more expensive, requires sedation and poses a low risk of complications with variceal bleeding. A recent report with a small number of patients proposed performing the CE-TTE in the upright position as another measure to increase the sensitivity of the test [64].…”

Section: Review: Poph and Hps M Porres-aguilar Et Almentioning

confidence: 99%

See 2 more Smart Citations

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Porres‐Aguilar

Altamirano²,

Torre-Delgadillo³

et al. 2012

European Respiratory Review

105

118

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Liver disease and portal hypertension can be associated with pulmonary vascular complications, including portopulmonary hypertension (POPH), characterised by an elevated mean pulmonary artery pressure secondary to an increased pulmonary vascular resistance, and hepatopulmonary syndrome (HPS), characterised by hypoxaemia due to pulmonary vasodilatation and shunting.Although clear diagnostic guidelines exist for both conditions on the basis of echocardiography, right heart catheterisation and arterial blood gases, there is considerable variation between centres regarding diagnosis and management of these conditions. Awareness of evaluation and management algorithms for POPH and HPS are critical for optimisation of outcomes in patients with these conditions. Key aspects of management of POPH and HPS include identification of patients likely to benefit from liver transplantation (LTx) and management before and after LTx. Although both disorders may improve after LTx, severe forms of POPH represent a contraindication to LTx.Novel approaches to the treatment of POPH and HPS offer new management options that may expand the pool of transplantable patients and improve overall outcomes.

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Section: Diagnostic Evaluation and Classificationmentioning

confidence: 88%

Section: Epidemiology and Risk Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Porres‐Aguilar

Altamirano²,

Torre-Delgadillo³

et al. 2012

European Respiratory Review

105

118

View full text Add to dashboard Cite

show abstract

“…The reported prevalence of HPS in adult cirrhotic patients is between 4 and 19% [14,15]. The reported prevalence of HPS in children with Budd-Chiari syndrome, chronic liver disease, biliary atresia and polysplenia syndrome, and portal vein obstruction is 28,[8][9][10][11][12][13]20, and 0.5%, respectively, and 17-19% in liver transplant recipients [3,5,[16][17][18][19]. The differing prevalence of HPS is primarily due to the heterogeneity of the disease groups and the applied criteria for HPS [14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…CEE was considered positive when echoes of air micro-bubbles in the left atrium were identified within 3-6 beats of their visualization in the right heart cavities with the absence of intracardiac communications [9]. The appearance of agitated saline in the left heart was categorized according to the size of the shunt (small, \5; moderate, 5-20; or large, [20 bubbles) [10]. Portopulmonary hypertension was excluded when the echocardiographic findings included a pulmonary artery systolic pressure \40 mmHg with interventricular wall flattening or right ventricular hypertrophy.…”

Section: Contrast-enhanced Echocardiographymentioning

confidence: 99%

Hepatopulmonary Syndrome in Children with Cirrhotic and Non-Cirrhotic Portal Hypertension: A Single-Center Experience

et al. 2011

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Budd‐Chiari syndrome in children: Radiological intervention and role of shear wave elastography in monitoring response

Samanta,

Srivastava,

Yadav

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesRadiological intervention (RI) is the preferred treatment in children with Budd‐Chiari syndrome (BCS). We studied the comparative long‐term outcome of BCS children, with and without RI and utility of liver and splenic stiffness measurement (LSM, SSM) by 2‐dimensional shear wave elastography (2D‐SWE) in assessing response.MethodsSixty children (40 boys, median age 10.5 [6.5–15.25] years) with BCS (29 newly diagnosed, 31 follow‐up) were evaluated. LSM and SSM by 2D‐SWE and vascular patency were monitored pre‐ and postprocedure (≥ 6 months postprocedure) in those undergoing RI. Medical therapy without anticoagulation and monitoring was done in subjects without RI. The RI and no‐RI groups were compared.ResultsAscites (54,90%), hepatomegaly (56,93%) and prominent abdominal‐veins (42,70%), were the commonest features. The majority (46,78%) had isolated hepatic vein block. 44 (73%) cases underwent RI, while 16 (27%) were managed conservatively. Both groups were similar at baseline. Post‐RI subjects showed significant improvement in clinical findings, liver functions and portal hypertension. LSM [33 (32–34.5) to 19.2 (18–20.67) kPa] and SSM [54.5 (52.3–57.6) to 28.9 (27.6–30.25) kPa] showed a significant decline from baseline value over a follow‐up of 12 (6–13) months. Gradual reduction occurred in the LSM and SSM over 1–5 years, with near‐normal LSM [10.2 (9.2–11.5) kPa] and SSM [22.3 (20.5–24.3) kPa] values in patients (n‐16) with > 5 years follow‐up. Patients without RI showed worsening in LSM and SSM. Hepatopulmonary syndrome and hepatocellular carcinoma developed in 4 (8%) and 1 (1.7%) cases respectively.ConclusionRI leads to clinical recovery and reduction with near normalization of LSM and SSM over long‐term follow‐up in children with BCS. 2D‐SWE is a promising tool to monitor outcomes.

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Saline Contrast Echocardiography in Patients With Hepatopulmonary Syndrome Awaiting Liver Transplantation

Cited by 40 publications

References 27 publications

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview

Hepatopulmonary Syndrome in Children with Cirrhotic and Non-Cirrhotic Portal Hypertension: A Single-Center Experience

Budd‐Chiari syndrome in children: Radiological intervention and role of shear wave elastography in monitoring response

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