Clinical ResearchOccurrence of hepatopulmonary syndrome in Budd–Chiari syndrome and the role of venous decompression☆
Section snippets
Patients and methods
In this prospective study, 31 cases of BCS (including the 2 reported previously,16 which presented one after the other and thus formed the first 2 cases of this consecutive series) were selected consecutively and studied between January 1999 and March 2001 from the Portal Hypertension Clinic and Medicine wards of the IPGMER and SSKM Hospital (Calcutta, India). Cases in which primary heart or lung disease was clinically suggested were excluded at the outset. Patients already treated with shunt
Results
Twenty-nine patients with BCS (20 men and 9 women; mean age, 33.6 ± 11.9 years) were included in the study. Fourteen had a history of jaundice, 26 had prominent back veins, and 21 had ascites. Only 4 had no esophageal varices. There were no significant differences in values of bilirubin (2.2 ± 2.82 vs. 1.4 ± 0.86 mg/dL, P = 0.3), albumin (3.3 ± 0.51 vs. 3.5 ± 0.61 g/dL, P = 0.4), alanine aminotransferase (39.3 ± 41.12 vs. 37.3 ± 27.86 IU/L, P = 0.8), and Child–Pugh score (7.6 ± 1.87 vs. 7.7 ±
Discussion
HPS has been reported predominantly in cirrhotic patients,7 with the incidence of positive CE varying from 5% to 47%19, 20 and prevalence of HPS between 5% and 29%.18, 21 Rarely does HPS develop in cases of noncirrhotic portal hypertension,8, 9, 10, 11, 12 and reports in cases of BCS are purely anecdotal.10, 12 Consequently, we were surprised to find positive CE in more than half of our 29 patients with BCS, with HPS present in more than one fourth of patients. A recent study of 45 cirrhotic
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Cited by (67)
Effect of Transjugular Intrahepatic Portosystemic Shunt Creation on Pulmonary Gas Exchange in Patients with Hepatopulmonary Syndrome: A Prospective Study
2019, Journal of Vascular and Interventional RadiologyCitation Excerpt :The mechanism by which TIPS creation improves pulmonary gas exchange is unknown but has been speculated to be due to improved ventilation-perfusion matching induced by a rise in cardiac output, resulting in increased blood flow to the upper lobes of the lung, where IPVD is usually less severe (17). This mechanism could also explain why cavoplasty can also improve pulmonary gas exchange in patients with HPS associated with BCS (9). The resolution of other major complications of portal hypertension is unlikely to occur, as patients without HPS in this study did not experience improvement in pulmonary gas exchange after TIPS creation.
Evidence for an Association Between Intrahepatic Vascular Changes and the Development of Hepatopulmonary Syndrome
2019, ChestCitation Excerpt :This hypothesis is supported by activation of the VEGF pathway in the lungs of rats with HPS.37 The observation of more frequent HPS in patients with liver hypoxia induced by Budd-Chiari syndrome (28%) or hypoxic hepatitis (46%) than in patients with extrahepatic portal vein thrombosis without cirrhosis (4%) is consistent with this view.38-41 This case-control study shows that HPS is associated with significant intrahepatic vascular changes as well as with features suggesting severe portal hypertension.
Role of Transjugular Intrahepatic Portosystemic Shunts in the Management of Hepatopulmonary Syndrome: A Systemic Literature Review
2015, Journal of Vascular and Interventional RadiologyHeptopulmonary syndrome
2015, Gastroenterologia y HepatologiaPulmonary Complications of Abdominal Diseases
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth EditionHepatopulmonary syndrome
2014, Clinics in Liver DiseaseCitation Excerpt :Although the hypoxemia may be severe while breathing ambient air, the partial pressure of oxygen (Pao2) usually increases to greater than 300 mm Hg by breathing 100% oxygen.47 As was also mentioned, the syndrome may occur in patients with comorbid primary lung diseases,53,54 and having cirrhosis is not imperative because HPS has been described in cases of acute and chronic hepatitis without cirrhosis or portal hypertension55,56 as well as in noncirrhotic portal hypertension without chronic liver disease.57–59 Several radiographic modalities exist to evaluate for the presence of IPVD.53,60,61
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Address requests for reprints to: Binay K. De, M.D., 64/4A/1A, Dr. SC Banerjee Road, Calcutta 700 010 W.B., India. e-mail: [email protected]; fax: (91) 033-4751799.