2006, Number 2
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Med Int Mex 2006; 22 (2)
Portopulmonary hypertension
Jiménez ZVH, Martínez LE, Gallardo ALA
Language: Spanish
References: 201
Page: 113-127
PDF size: 255.07 Kb.
ABSTRACT
Pulmonary involvement is common in patients with portal hypertension and can be manifested in several manners. Changes in pulmonary arterial resistance, manifesting either as the hepatopulmonary syndrome or portopulmonary hypertension, have been increasingly recognized in these patients in recent years. This review summarizes the clinicopathologic features, diagnostic criteria, as well as the latest concepts in the pathogenesis and management of the portopulmonary hypertension, which is defined as an elevated pulmonary artery pressure in the setting of an increased pulmonary vascular resistance and a normal wedge pressure in a patient with portal hypertension.
REFERENCES
Scott VL, Dodson SF, Kang Y. The hepatopulmonary syndrome. Surg Clin North Am 1999;79(1):23-39.
Jones FD, Kuo PC, Johnson LB, et al. The coexistence of portopulmonary hypertension and hepatopulmonary syndrome. Anesthesiology 1999;2:626-30.
Tasaka S, Kanazawa M, Nakamura H, et al. An autopsied case of primary pulmonary hypertension complicated by hepatopulmonary syndrome. Nihon Kyobu Shikkan Gakkai Zasshi 1995;33:90-94.
DeWolf A, Scott V, Gasior T. Pulmonary hypertension and liver transplantation. Anesthesiology 1993:78:213.
Kaspar MD, Ramsay MA, Shuey CB, et al. Severe pulmonary hypertension and amelioration of hepatopulmonary syndrome after liver transplantation. Liver Transpl Surg 1998;4:177-9.
Mal H, Burgiere O, Durand F, et al. Pulmonary hypertension following hepatopulmonary syndrome in a patient with cirrhosis. J Hepatol 1999;31:360-4.
Martinez-Pali G, Barvera JA, Taura P, et al. Severe portopulmonary hypertension after liver transplantation in a patient with preexisting hepatopulmonary syndrome. J Hepatol 1999;31;1075-9.
The international primary pulmonary hypertension study. Chest 1994;105:37S-41S.
Krowka MJ, McGoon MD. Portopulmonary hypertension: the next step. Chest 1997;112:869-0.
Kuo PC, Plotkin JS, Gaine S, et al. Portopulmonary hypertension and the liver transplant candidate. Transplantation 1999;67:1087-93.
Mackworth-Young CG, Gharavi AE, Boey ML, et al. Portal and pulmonary hypertension in a case of systematic lupus erythematosus: possible relationship with a clotting abnormality. Eur J Rheum Inflamm 1984;7:71-4.
Bayraktar Y, Tanaci N, Egesel T, el al. Antiphospholipid syndrome presenting as portopulmonary hypertension. J Clin Gastroenterol 2001;32:359-61.
De Clerck LS, Michielsen PP, Ramael MR, et al. Portal and pulmonary vessel thrombosis associated with systemic lupus erythematosus and anticardiolipin antibodies. J Rheumatol 1991;18:1919-21.
Sawai T, Tutikawa K, Watanabe T, et al. A case of mixed connective tissue disease complicating pulmonary hypertension and portal hypertension. Ryumachi 1988;28:164-9.
Ozawa T, Nakagawa O, Hasewaga S, et al. A case of mixed connective tissue accompanied with idiopathic portal hypertension and pulmonary hypertension. Nippon Naika Gakkai Zasshi 1989;78:1799-800.
Chaves E. The pathology of the arterial pulmonary vasculature in Manson’s schistosomiasis. Dis Chest 1966;50:72-77.
Emanuel A, Prata A, Bina JC, et al. Peristent schistosomal pulmonary hypertension in a patient after reversion of a hepato-splenic form: presentation of a case. Rev Soc Bras Med Trop 1986;19:171-2.
Watt G, Long GW, Calubaquib C, et al. Cardiopulmonary involvement rare in severe Schistosoma japonicum infection. Tro Geogr Med 1986;38:233-9.
Cornet A, Barbier JP, Debesse B, et al. Sarcoidosis and portal and pulmonary hypertension: a case report. Ann Intern Med 1980;131:431-4.
Salazar A, Mana J, Sala J, et al. Combined portal and pulmonary hypertension and sarcoidosis. Respiration 1994;61:117-9.
Kuramochi S, Tashiro Y, Torikata C, et al. Systemic lupus erythematosus associated with multiple nodular hyperplasia of the liver. Acta Pathol Jpn 1982;32:547-60.
Ansari A, Larson PH, Bates HD. Vascular manifestations of systemic lupus erythematosus. Angiology 1986;37:423-32.
Pare PD, Chan-Yan C, Wass H, et al. Portal and pulmonary hypertension with microangiopathic hemolytic anemia. Am J Med 1983;74:1093-6.
Mandell MS, Groves BM. Pulmonary hypertension in chronic liver disease. Clin Chest Med 1996;17:17-33.
Mantz FA, Craig E. Portal axis thrombosis with spontaneous porto-caval shunt and resultant cor pulmonale. Arch Pathol Lab Med 1951;52:91-7.
A fifty six year old woman with jaundice and pulmonary hypertension. Am J Med 1969;47:287-98.
Levine OR, Harris RC, Blanc WA, et al. Progressive pulmonary hypertension in children with portal hypertension. J Pediatr 1973;83:964-72.
Lebrec D, Capron JP, Dhumeaux D, et al. Pulmonary hypertension complicating portal hypertension. Am Rev Respir Dis 1979;120:849-56.
Molden D, Abraham JL. Pulmonary hypertension: its association with hepatic cirrhosis and iron accumulation. Arch Pathol Lab Med 1982;106:328-31.
Wagenvoort CA. Medial defects of lung vessels: a new cause of pulmonary hypertension. Hum Pathol 1986;17:722-6.
Booth H, Visser FC, Thijs JC, et al. Pulmonary hypertension complicating portal hypertension: a case report with suggestions for a different therapeutic approach. Eur Heart J 1987;10:656-60.
Edwards BS, Weir EK, Edwards WD, et al. Coexistent pulmonary and portal hypertension: morphologic and clinical features. J Am Coll Cardiol 1987;10:1233-8.
Chan T, Palevski HI, Miller WT, et al. Pulmonary hypertension complicating portal hypertension: findings on chest radiographs. AJR Am J Roentgenol 1988;151:909-14.
Maev IV, Merzilikin LA, Vorobev LP, et al. Study of the right heart and external respiratory functions in patients with liver cirrhosis by doppler echocardiography. Sov Med 1991;8:11-13.
Hadengue A, Benhayoun MK, Lebrec D, et al. Pulmonary hypertension complicating portal hypertension: prevalence and relation to splanchnic hemodynamics. Gastroenterology 1991;100:520-8.
Robalino BD, Moodie DS. Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. J Am Coll Cardiol 1991;17:492-8.
Moscoso G, Mieli-Vergani G, Mowat AP, et al. Sudden death caused by unexpected pulmonary arterial hypertension, 10 years after surgery for extrahepatic biliary atresia. J Pediatr Gastroenterol Nutr 1991;12:388-93.
Rossi SO, Gilbert-Barnes E, Saari T, et al. Pulmonary hypertension with coexisting portal hypertension. Pediatr Pathol 1992;12:433-9.
Goenka MK, Mehta SK, Mallik AK, et al. Fatal pulmonary arterial hypertension complicating non-cirrhotic portal fibrosis. Am J Gastroenterol 1992;87:1203-05.
Yoshida EM, Erb SR, Pflugfelder PW, et al. Single lung vs liver transplantation for the treatment of portopulmonary hypertension: a comparison of two patients. Transplantation 1993;55:688-90.
Tokiwa K, Iwai N, Nakamura K, et al. Pulmonary hypertension as a fatal complication of extrahepatic portal hypertension. Eur J Pediatr Surg 1993;3:373-5.
Woolf D, Voigt MD, Jaskiewicz K, et al. Pulmonary hypertension associated with non cirrhotic portal hypertension in systemic lupus erythematosus. Postgrad Med J 1994;70:41-3.
Yoshida EM, Erb SR, Ostrow DN, et al. Pulmonary hypertension associated with primary biliary cirrhosis in the absence of portal hypertension: a case report. GUT 1994;35:280-2.
Koneru B, Ahmed S, Weisse AB, et al. Resolution of pulmonary hypertension of cirrhosis after liver transplantation. Transplantation 1994;58:1133-5.
Levy MT, Torzillo P, Bookallil M, et al. Case report: delayed resolution of severe pulmonary hypertension after isolated liver transplantation in a patient with cirrhosis. J Gastroenterol Hepatol 1996;11:734-7.
Kuo PC, Schroeder RA, Vagelos RH, et al. Volume mediated pulmonary responses in liver transplant candidates. Clin Transplant 1996;10:521-7.
Murata K, Shimizu A, Takase K, et al. Asymptomatic primary pulmonary hypertension associated with liver cirrhosis. J Gastroenterol 1997;32:102-4.
Rich S. Primary pulmonary hypertension: executive summary from the world symposium. WHO programme on cardiovascular diseases, 1998.
Cohen MD, Rubin LJ, Taylor WE, et al. Primary pulmonary hypertension: an unusual case associated with extrahepatic portal hypertension. Hepatology 1983;3:588-92.
Soh H, Hasegawa T, Sasaki T, et al. Pulmonary hypertension associated with postoperative biliary atresia: report of two cases. J Pediatr Surg 1999;34:1779-81.
Klochkov SA, Alekseevskikh lu G, Seniakovich VM. Histologic changes in the lungs and heart in children with extrahepatic blockade of the portal circulation. Arkh Patol 1996;58:54-8.
De BK, Pal A, Santra A, et al. Primary pulmonary hypertension in non cirrhotic portal fibrosis. Indian J Gastroenterol 1997;16:85-7.
Sekiguchi Y, Amano K, Takano Y, et al. Portal and pulmonary hypertension in a patient with MCTD. Ryumachi 1999;39:657-63.
Bernthal AC, Eybel CE, Payne JA. Primary pulmonary hypertension after porto-caval shunt. J Clin Gastroenterol 1983;5:353-6.
Mikhelson VA, Trifonova NA, Ismail-Zade IA, et al. Disorders of hemodynamics and their correction in children with non hepatic portal hypertension during the course of surgical treatment. Nesteziol Reanimatol 1993;(1):13-6.
Ismail-Zade IA, Trifonova NA, Razumovski AY, et al. Haemodynamic changes in children with portal hypertension during the postoperative period. Pediatr Anaesth 1995;5:311-7.
McDonnell PJ, Toye OA, Hutchins GM. Primary pulmonary hypertension and cirrhosis: are they related? Am Rev Respir Dis 1983;127:437-41.
Sen S, Biswas PK, Biswas J, et al. Primary pulmonary hypertension in cirrhosis liver. Indian J Gastroenterol 1999;18:158-60.
Yang YY, Lin HC, Lee WC, et al. Portopulmonary hypertension distinctive hemodynamic and clinical manifestations. J Gastroenterol 2001;36:181-6.
Taura P, García Valdecasas JC, Beltrán J, et al. Moderate primary pulmonary hypertension in patients undergoing liver transplantation. Anesth Analg 1996;83:675-80.
Castro M, Growka MJ, Scroeder DR, et al. Frequency and clinical implications of increased pulmonary artery pressures in liver transplant patients. Mayo Clinic Proc 1996;71:543-51.
Ramsay MA, Simpson BR, Nguyen AT, et al. Severe pulmonary hypertension in liver transplant candidates. Liver Transplant Surg 1997;3:494-500.
Donovan CL, Marcovitz PA, Punch JD, et al. Two-dimensional and dobutamine stress echocardiography in the preoperative assessment of patients with end stage liver disease prior to orthotopic liver transplantation. Transplantation 1996;61:1180-8.
Auletta M, Oliveiro U, Lasiulolo L, et al. Pulmonary hypertension associated with liver cirrhosis: an echocardiographic study. Angiology 2000;51:1013-20.
Kibria G, Smith P, Heath D, et al. Observations on the rare association between portal and pulmonary hypertension. Thorax 1980;35;945-9.
Hiyama E. Pulmonary vascular changes after portosystemic shunt operation in rats. Nippon Geka Gakkai Zasshi 1989;90:874-85.
Budhiraja R, Hassoun PM. Portopulmonary hypertension; a tale of two circulations. Chest 2003;123(2):521-48.
Tuder RM, Cool CD, Yeager M, et al. The pathobiology of pulmonary hypertension: endothelium. Clin Chest Med 2001;22:405-18.
Yeager ME, Halley GR, Golpon HA, et al. Microsatellite instability of endothelial cell growth and apoptosis genes within plexiform lesions in primary pulmonary hypertension. Circ Res 2001;88:E2-E11.
Higenbottam TW, Laude EA. Endothelial dysfunction providing the basis for the treatment of pulmonary hypertension. Giles F. Filley lecture. Chest 1998;114:72S-9S.
Fishman AP. Etiology and pathogenesis of primary pulmonary hypertension: a perspective. Chest 1998;114:242S-7S.
Welsh CH, Hassell KL, Badesch DB, et al. Coagulation and fibrinolytic profiles in patients with severe pulmonary hypertension. Chest 1996;110:710-7.
Gerber JG, Voelkel N, Nies AS, et al. Moderation of hypoxic vasoconstriction by infused arachidonic acid; role of PGI2. J Appl Physiol 1980;49:107-12.
Geraci MW, Gao B, Sheperd DC, et al. Pulmonary prostacyclin synthase overexpression in transgenic mice protect against development of hypoxic pulmonary hypertension. J Clin Invest 1999;103:1509-15.
Hara S, Morishita R, Tone Y, et al. Overexpression of prostacyclin synthase inhibits growth of vascular smooth muscle cells. Biochem Biophys Res Commun 1995;216:862-7.
Christman BW, McPherson CD, Newman JH, et al. An imbalance between the excretion of thromboxane and prostacyclin metabolites in pulmonary hypertension. NEJM 1992;327:70-5.
Tuder RM, Cool CD, Geraci MW, et al. Prostacyclin synthase expression is decreased in lungs from patients with severe pulmonary hypertension. Am J Respir Crit Care Med 1999;159:1925-32.
Hassoun PM, Thappa V, Landmann MJ, et al. Endothelin 1 mitogenic activity on pulmonary artery smooth muscle cells and release from hypoxic endothelial cells. Proc Soc Exp Biol Med 1992;199:165-70.
Stelzner TJ, O’Brien RF, Yanagiosawa M, et al. Increased lung endothelin 1 production in rats with idiopathic pulmonary hypertension. Am J Physiol 1992;262:L614-L20.
Yoshibayashi M, Nishioka K, Nakao K, et al. Plasma endothelin concentrations in patients with pulmonary hypertension associated with congenital heart defects: evidence for increased production of endothelin in pulmonary circulation. Circulation 1991;84:2280-5.
Cody RJ, Haas GJ, Binkley PF, et al. Plasma endothelin 1 correlates with extent of pulmonary hypertension in patients with chronic congestive heart failure. Circulation 1992;85:504-9.
Stewart DJ, Levy RD, Cernacek P, et al. Increased plasma endothelin 1 in pulmonary hypertension: marker or mediator of disease? Ann Intern Med 1991;114:464-9.
Giaid A, Yanagisawa M, Langleben D, et al. Expression of endothelin-1 in the lungs of patients with pulmonary hypertension. NEJM 1993;328:1732-9.
Vincent JA, Ross RD, Kassab J, et al. Relation of elevated plasma endothelin in congenital heart disease to increased pulmonary blood flow. Am J Cardiol 1993;71:1204-7.
Chang H, WuGJ, Wang SM, et al. Plasma endothelin-1 levels and surgically correctable pulmonary hypertension. Ann Thorac Surg 1993;55:450-8.
Kamath PS, Tyce GM, Miller VM, et al. Endothelin-1 modulates intrahepatic resistance in a rat model of non cirrhotic portal hypertension. Hepatology 1999;30:401-7.
Moore K, Wendon J, Frazer M, et al. Plasma endothelin immunoreactivity in liver disease and the hepatorenal syndrome. NEJM 1992;327;1774-8.
Zhan Q, Guo J, Tang J, et al. Alternation of the level of plasma calcitonin gene related peptide and endothelin-1 in liver cirrhosis. Zhongua Nei Ke Za Zhi 1999;38:91-3.
Shah V, Torurner M, Haddad F, et al. Impaired endothelial nitric oxide synthase activity associated with enhanced caveolin binding in experimental cirrhosis in the rat. Gastroenterology 1999;117:1222-8
Cella G, Bellotto F, Tona F, et al. Plasma markers of endothelial dysfunction in pulmonary hypertension. Chest 2001;120:1226-30.
Nichols WC, Koller DL, Slovis B, et al. Localization of the gene for familial primary pulmonary hypertension chromosome 2q31-32. Nat Gene 1997;15:277-80.
Morse JH, Jones AC, Barst RJ, et al. Mapping of familial primary pulmonary hypertension locus (PPH1) to chromosome 2q31-q32. Circulation 1997;95:2603-6.
Eddahibi S, Humbert M, Fadel E, et al. Serotonin transporter overexpression is responsible for pulmonary artery smooth muscle hyperplasia in primary pulmonary hypertension. J Clin Invest 2001;108:1141-50.
Flemale A, Sabot JP, Popijn M, et al. Pulmonary hypertension associated with portal thrombosis. Eur J Respir Dis 1985;66:224-8.
Egermayer P, Town GI, Peacock AJ. Role of serotonin in the pathogenesis of acute and chronic pulmonary hypertension. Thorax 1999;54:161-8.
Lee SL, Wang WW, Lanzillo JJ, et al. Serotonin produces both hyperplasia and hypertrophy of bovine pulmonary artery smooth muscle cell culture. Am J Physiol 1994;266:L46-L52.
Eddahibi S, Chouaid C, Sediame S, et al. Serotonin uptake and citalopram binding in platelets from patients with chronic pulmonary hypertension. Am J Respir Crit Care Med 1999;159A:165.
Herve P, Launay JM, Scrobohaci ML, et al. Increased plasma serotonin in primary pulmonary hypertension. Am J Med 1995;99:249-54.
Laffi G, Marra F, Gresele P, et al. Evidence for a storage pool defect in platelets from cirrhotic patients with deffective aggregation. Gastroenterology 1992;103;641-6.
Senior RM, Britton RC, Turino GM, et al. Pulmonary hypertension associated with cirrhosis of the liver and with portocaval shunts. Circulation 1968;37:88-96.
Lai KS, McFadzean AJ, Yeung R. Microembolic pulmonary hypertension in pyogenic cholangitis. BMJ 1968;30:723-5.
Lal S, Fletcher E. Pulmonary hypertension and portal venous system thrombosis. Br Heart J 1968;30:723-5.
Herve P, Lebrec D, Brenot F, et al. Pulmonary vascular disorders in portal hypertension. Eur Respir J 1998;11:1153-66.
Larrey D, Theodore C, Molas G, et al. Primary biliari cirrhosis and pulmonary arterial hypertension. Gastroenterol Clin Biol 1981;5:588-9.
Wallwork J, Williams R, Calne RY. Transplantation of liver, heart and lungs for primary biliary cirrhosis and primary pulmonary hypertension. Lancet 1987;2;182-5.
Mansour M, Lassabe G, Rauscher M, et al. Pulmonary arterial hypertension and primary biliary cirrhosis. Arch Mal Coreur Vaiss 1995;88:503-5.
Koening A, Dietle A, Chauvin M, et al. Primary pulmonary hypertension associated with primary biliary cirrhosis. Press Med 1998;27;1329.
Aoki A, Kenmochi H, Hagiwara E, et al. Pulmonary hypertension in a patient with primary Sjogren’s syndrome, Hashimoto disease and primary biliary cirrhosis. Nihon Rinsho Meneki Gakkai Kaishi 2000;23;462-9.
Carter EP, Sato K, Morio Y, et al. Inhibition of K (Ca) channels restores blunted hypoxic pulmonary vasoconstriction in rats with cirrhosis. Am J Physiol Lung Cell Mol Physiol 2000;279:L903-L10.
Yi ES, Kim H, Ahn H, et al. Distribution of obstructive intimal lesions and their cellular phenotypes in chronic pulmonary hypertension: a morphometric and immunohistochemical study. Am J Respir Crit Care Med 2000;162:1577-86.
Cool CD, Stewart JS, Werahera P, et al. Three-dimensional reconstruction of pulmonary arteries in plexiform pulmonary hypertension using cell specific markers: evidence for a dynamic and heterogeneous process of pulmonary endothelial cell growth. Am J Pathol 1999;155:411-9.
Pietra GG, Edwards WD, Kay JM, et al. Histopathology of primary pulmonary hypertension; a qualitative and quantitative study of pulmonary blood vessels from 58 patients in the national heart, lung and blood institute, primary pulmonary hypertension registry. Circulation 1989;80:1198-206.
Mason NA, Springall DR, Burke M, et al. High expression of endothelial nitric oxide synthase in plexiform lesions of pulmonary hypertension. J Pathol 1998;185:313-8.
Kuo PC, Plotkin JS, Johnson LB, et al. Distinctive clinical features of portopulmonary hypertension. Chest 1997;112:980-6.
Prager M, Cauldwell C, Ascer N, et al. Pulmonary hypertension associated with liver disease. Anesthesiology 1992;77:375-8.
Rich S, Dantzker DR, Ayres SM, et al. Primary pulmonary hypertension; a national prospective study. Ann Intern Med 1987;107:216-23.
Weissman E, Becker NH. Interstitial lung disease in primary biliary cirrhosis. Am J Med Sci 1983;285:21-7.
Osaka M, Aramaki T, Okumura H, et al. Primary biliary cirrhosis with fibrosing alveolitis. Gastroenterol Jpn 1988;23:457-60.
Strobel ES, Bonnet RB, Werner P, et al. Bronchiolitis obliterans organizing pneumonia and primary biliary cirrhosis like lung involvement in a patient with primary biliary cirrhosis. Clin Rheumatol 1998;17:246-9.
Bissuel F, Bizollon T, Dijoud F, et al. Pulmonary hemorrage and glomerulonephritis in primary biliary cirrhosis. Hepatology 1992;16:1357-61.
Plauchu M, Chapuy H, de Montgolfier R, et al. Pleural effusions in liver cirrhosis. J Med Lyon 1970;51;641-52.
Valeriano V, Funaro S, Lionetti R, et al. Modification of cardiac function in cirrhotic patients with and without ascites. Am J Gastroenterol 2000;95:3200-05.
Epstein SK, Ciubotaru RL, Zilerberg MD, et al. Analysis of impaired exercise capacity in patients with cirrhosis. Dig Dis Sci 1998;43:1701-7.
Campillo B, Fouet P, Bonnet JC, et al. Submaximal oxygen consumption in liver cirhosis: evidence of severe functional aerobic impairment. J Hepatol 1990;10:163-7.
Grose RD, Nolan J, Dillon DF, et al. Exercise induced left ventricular dysfunction in alcoholic and non alcoholic cirrhosis. J Hepatol 1995;22;326-32.
Cabre E, Gassull MA. Nutritional issues in cirrhosis and liver transplantation. Curr Opinion Nutr Metab Care 1999;2:373-80.
Roth K, Lynn J, Zhong Z, et al. Dying with end stage liver disease with cirrhosis: insights from SUPPORT; Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment. J Am Geriatr Sc 2000;48:S122-S30.
Agusti AG, Roca J, Rodriguez -Roisin R. Mechanisms of gas exchange impairment in patients with liver cirrhosis. Clin Chest Med 1996;17:49-66.
King PD, Rumbaut R, Sanchez C. Pulmonary manifestations of chronic liver disease. Dig Dis 1996;14:73-82.
Daoud FS, Reeves JT, Scaefer JW. Failure of hypoxic pulmonary vasoconstriction in patients with liver cirrhosis. J Clin Invest 1972;51:1076-80.
Krowka MJ. Hepatopulmonary syndrome vs portopulmonary hypertension; distinctions and dilemmas. Hepatology 1997;25:1282-4.
Kuo PC, Plotkin. Distinctive clinical features of portopulmonary hypertension. Chest 1997;112;980-6.
Kim WR, Krowka MJ, Plevak DJ, et al. Accuracy of doppler echocardiography in the assessment of pulmonary hypertension in liver transplant candidates. Liver Transpl 2000;6:453-8.
Torregosa M, Genesca J, Gonzalez A, et al. Role of doppler echocardiography in the assessment of portopulmonary hypertension in liver transplantation candidates. Liver transplantation 2001;71:572-4.
Rettke SR, Chantigian RC, Janossy TA, et al. Anesthesia approach to hepatic transplantation. Mayo Clinic Proc 1989;64:224-31.
Waxman AB. Pulmonary function test abnormalities in pulmonary vascular disease and chronic heart failure. Clin Chest Med 2001;22:751-8.
Rhodes J, Barst RJ, Garofano RP, et al. Hemodynamic correlates of exercise function in patients with primary pulmonary hypertension. J Am Coll Cardiol 1991;18:1738-44.
D’Alonso GE, Gianotti L, Dantzker DR. Noninvasive assessment of hemodynamic improvement during chronic vasodilator therapy in obliterative pulmonary hypertension. Am Rev Respir Dis 1986;133:380-4.
Kuo PC, Johnson LB, Plotkin JS, et al. Continuous intravenous infusion of epoprostenol for the treatment of portopulmonary hypertension. Transplantation 1997;63:604-6.
Simonneau G, Barst RJ, Galie N, et al. Continuous subcutaneous infusion of teprostinil, a prostacyclin analogue, in patients with pulmonary hypertension; a double blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med 2002;165:800-4.
Nagaya N, Uematsu M, Okano Y, et al. Effect of an orally active prostacyclin analogue on survival outpatients with primary pulmonary hypertension. J Am Coll Cardiol 1999;34;1188-92.
Hoeper MM, Schwarze M, Ehlerding S, et al. Long term treatment of primary pulmonary hypertension with aerosolized iloprost, a prostacyclin analogue. NEJM 2000;342:1866-70.
Wilkens H, Guth A, Konig J, et al. Effect of inhaled iloprost plus oral sildenafil in patients with primary pulmonary hypertension. Circulation 2001;104;1218-22.
Nagaya N, Uematsu M, Oya H, et al. Short -term oral administration of L arginine improves hemmodynamics and exercise capacity in patients with precapillary pulmonary hypertension. Am J Respir Crit Care Med 2001;163:887-91.
Findlay JY, Harrison BA, Plevak DL, et al. Inhaled nitric oxide reduces pulmonary artery pressures in portopulmonary hypertension. Liver Transpl Surg 1999;5:381-7.
Buchhorn R, Hulpke -Wette JA, et al. B-blocker therapy in an infant with pulmonary hypertension. Eur J Pediatr 1999;158:1007-8.
Ribas J, Angrill J, Barbera JA, et al. Isosorbide-5 mononitrate in the treatment of pulmonary hypertension associated with portal hypertension. Eur Respir J 1999;13;210-12.
Rubin LJ, Badesch DB, Barst RJ, et al. Bosentan therapy for pulmonary arterial hypertension. NEJM 2002;346:896-903.
Barst RJ, Rich S, Widlitz A, et al. Clinical efficacy of sitaxsentan, an endothelin - a receptor antagonist, in patients with pulmonary arterial hypertension; open-label pilot study. Chest 2002;121:1860-8.
Dennis CM, McNeil KD, Dunning J, et al. Heart lung liver transplantation. J Heart Lung Transplant 1996;15:536-8.
Pirenne J, Verleden G, Nevens F, et al. Combined liver and lung transplantation in candidates with refractory portopulmonary hypertension. NEJM 1992;327;76-81.
Rich S, Kaufmann E, Levy S, et al. The effect of high doses of calcium- channel blockers on survival in primary pulmonary hypertension. NEJM 1992;327:76-81.
Vorobev LP, Maev IV, Andreev NG. Drug therapy of pulmonary and portal hypertension in liver cirrhosis. Klin Med 1991;69:64-7.
McLaughlin VV, Genthener DE, Panella MM, et al. Compassionate use of continuous prostacyclin in the management of secondary pulmonary hypertension; a case series. Ann Intern Med 1999;130:740-3.
Krowka MJ, Fratz RP, McGoon MD, et al. Improvement in pulmonary hemodynamics during intravenous epoprostenol: a study of 15 patients with moderate to severe portopulmonary hypertension. Hepatology 1999;30:641-8.
Scroeder RA, Rafii AA, Plotkin JS, et al. Use of aerosolized epoprostenol in the treatment of portopulmonary hypertension. Transplantation 2000;70:548-50.
Bozkurt S, Ersoy E, Tekyn HE, et al. The cytoprotective effect of iloprostol against carbon tetrachloride induced necrosis in rat liver. Res Commun Mol Pathol Pharmacol 1997;95:343-6.
Davies DS, Fawthrop DJ, Nasseri-Sina P, et al. Paracetamol toxicity and its prevention by cytoprotection with iloprost. Toxicol Lett 1992;64-5.
Nasseri-Sina P, Fawthrop DJ, Wilson J, et al. Cytoprotection by iloprost against paracetamol induced toxicity in hamster isolated hepatocytes, Br J Pharmacol 1992;105:417-23.
Findlay JY, Plevak DJ, Krowka MJ, et al. Progressive splenomegaly after epoprostenol therapy in portopulmonary hypertension. Liver Transpl Surg 1999;5:362-5.
Tilton RG, Munsch CL, Sherwood SJ, et al. Attenuation of pulmonary vascular hypertension and cardiac hypertrophy with sitaxsentan sodium, an orally active EI (A) receptor antagonist. Pul Pharmacol Ther 2000;13:87-97.
Williamson DJ, Wallman LL, Jones R , et al. Hemodynamic effects of bosentan, an endothelin receptor antagonist, in patients with pulmonary hypertension. Circulation 2000;102:411-8.
De Wolf AM, Scott V, Bjerke R, et al. Hemodynamic effects of inhaled nitric oxide in four patients with severe liver disease and pulmonary hypertension. Liver Transpl Surg 1997;3:594-7.
Ramsay MA, Schmidt A, Hein HA, et al. Nitric oxide does not reverse pulmonary hypertension associated with end stage liver disease: a preliminary report. Hepatology 1997;25:524-7.
Abrams D, Schulze-Neick I, Magee AG. Sildenafil as a selective pulmonary vasodilator in childhood primary pulmonary hypertension. Heart 2000;84:E4.
Schumacher YO, Zdebick A, Huonker M, et al. Sildenafil in HIV related pulmonary hypertension. AIDS 2001;15:1747-8.
Zhao L, Mason NA, Morell NW, et al. Sildenafil inhibit hypoxia induced pulmonary hypertension. Circulation 2001;104:424-8.
Langle F, Roth E, Steininger R, et al. Arginase release following liver reperfusion: evidence of haemodynamic action of arginase infusions. Transplantation 1995;59:1542-9.
Kobayashi H, Nonami T, Kurokawa T, et al. Role of endogenous nitric oxid in ischemia reperfusion injury in rat liver. J Surg Res 1995;59:772-9.
Shimamura T, Zhu Y, Zhang S, et al. Protective role of nitric oxide in ischemia and reperfusion injury of the liver. J Am Coll Surg 1999;188:43-52.
Shiraishi M, Hiroyasu S, Nagahama M, et al. Role of exogenous L-arginine in hepatic ischemia reperfusion injury. J Surgery Res 1997;69:429-34.
Nilsson B, Yoshida T, Delbreo D, et al. Pretreatment with L-arginine reduces ischemia/reperfusion injury of the liver. Transplant Proc 1997;29:3111-2.
Higa T, Shiraishi M, Mamadi T, et al. Limitations of exogenous L-arginine in exerting a cytoprotective effect on hepatic ischemia/reperfusion injury. Surg Today 2000;30:352-9.
De Wolf AM, Scott VL, Gasior T, et al. Pulmonary hypertension and liver transplantation. Anesthesiology 1993;78:213-4.
Scott V, De Wolf A, Kang Y, et al. Reversibility of pulmonary hypertension after liver transplantation: a case report. Transplant Proc 1993;25:1789-90.
Losay J, Piot D, Bougaran J, et al. Early liver transplantation is crucial in children with liver disease and pulmonary artery hypertension. J Hepatol 1998;28:337-42.
Schott R, Chaouat A, Launoy A, et al. Improvement of pulmonary hypertension after liver transplantation. Chest 1999;115:1748-9.
Mandell MS. Hepatopulmonary syndrome and portopulmonary hypertension in the model for end stage liver disease (MELD) era. Liver Traspl 2004;10:S54-S8.
Krowka MJ, Plevak DJ, Findlay JY, et al. Pulmonary hemodynamics and perioperative cardiopulmonary related mortality in patients with portopulmonary hypertension undergoing liver transplantation. Liver Transplant 2000;6:442-50.
Plevak D, Krowka MJ, Rettke S, et al. Successful liver transplantation in patients with mild to moderate pulmonary hypertension. Transplant Proc 1993;25:1840.
Rfanan AL, Maurer J, Mehta AC, et al. Progressive portopulmonary hypertension after liver transplantation treated with epoprostenol. Chest 2000;118:1497-500.
Mandell MS, Groves BM, Duke J. Progressive plexogenic pulmonary hypertension following liver transplantation. Transplantation 1995;59:1488-90.
Prager MC, Cauldwell CA, Ascher NL, et al. Pulmonary hypertension associated with liver disease is not reversible after liver transplantation. Anesthesiology 1992;77:375-8.
Kett DH, Acosta RC, Campos MA, et al. Recurrent portopulmonary hypertension after liver transplantation; management with epoprostenol and resolution after transplantation. Liver Transplant 2001;7:645-8.
Plotkin JS, Kuo PC, Rublin LJ, et al. Successful use of chronic epoprostenol as a bridge to liver transplantation in severe portopulmonary hypertension. Transplantation 1998;65:457-9.
Tan HP, Markowitz JS, Montgomery RA, et al. Liver transplantation in patients with severe portopulmonary hypertension treated with perioperative chronic intravenous epoprostenol. Liver Transplant 2001;7:745-9.
Kahler CM, Graziadei I, Widemann CJ, et al. Successful use of continous intravenous prostacylicn in a patient with severe portopulmonary hypertension. Wien Klin Wochenschr 2000;112:637-40.
Neumann UP, Kaisers U, Langrehr JM, et al. Adminsitration of prostacyclin after liver transplantation; a placebo controlled randomized trial. Clin Transpl 2000;14;70-4.
Kinirons B, Kuhlman L, Mori K, et al. Management of perioperative pulmonary hypertension in a patient presenting for a portosystemic shunt. Eur J Anaesthesiol 1999;16:728-32.
Tarquino M, Geggel RL, Strauss RS, et al. Treatment of pulmonary hypertension with inhaled nitric oxide during hepatic transplantation in an adolescent: reversibility of pulmonary hypertension after transplantation. Clin Pediatr 1998;37:505-9.
Cheng DC, Edelist G. Isoflurane and primary pulmonary hypertension. Anaesthesia 1988;43:22-4.
Cheng EY, Woehlck HJ. Pulmonary artery hypertension complicating anesthesia for liver transplantation. Anesthesiology 1992;77:389-92.
Janssens SP, Bloch KD, Nong Z, et al. Adenoviral mediated transfer of the human endothelial nitric oxide synthase gene reduces acute hypoxic pulmonary vasoconstriction in rats. J Clin Invest 1996;98;317-24.
Campbell AI, Zhao Y, Sandhu R, et al. Cell based gene transfer of vascular endothelial growth factor attenuates monocrotaline-induced pulmonary hypertension. Circulation 2001;104:2242-8.
Champion HC, Bivalacqua TJ, Toyoda K, et al. In vivo gene transfer of prepro-calcitonin gene related peptide to the lung attenuetes chronic hypoxia induced pulmonary hypertension in the mouse. Circulation 2000;101;923-30.
Nagaya N, Yokoyama C, Kyotani S, et al. Gene transfer of human prostacyclin synthase ameliorates monocrotaline induced pulmonary hypertension in rats. Circulation 2000;102;2005-10.
Mandell MS, Krowka MJ. Formation of a national database on pulmonary hypertension and hepatopulmonary syndrome in chronic liver disease. Anesthesiology 1997;87:450-1.
Martínez PG, Balust V, Beltran J, et al. Portopulmonary hypertension and hepatopulmonary syndrome: Two differents entities affecting pulmonary vasculature in liver disease. Crit Care Med 2005;33:1.
Krowka MJ. Portopulmonary hypertension: diagnostic advances and caveats. Liver Traspl 2003;9(12):1336-7.
Hoeper MM, Krowka MJ, Strassburgh CP. Portopulmonary hypertension and hepatopulmonary syndrome. Lancet 2004;363:1461-8.
Maruyama T, Ohsaki K, Shimoda S, et al. Thromboxane dependent portopulmonary hypertension. Am J Med 2005;118:547.