medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2016, Number 1

<< Back Next >>

Ann Hepatol 2016; 15 (1)

Intrapulmonary vascular dilation in children with chronic liver diseases: pre- and post-liver transplantation

Khositseth A, Treepongkaruna S, Khemakanok K, Teeraratkul S, Pansrimangkorn V, Thirapattaraphan C, Leelaudomlipi S

Language: English
References: 27
Page: 47-52
PDF size: 196.32 Kb.


ABSTRACT

Background and study aims. Chronic liver disease (CLD) can cause hepatopulmonary syndrome (HPS), defined as triad of liver disease, hypoxemia, and intrapulmonary vascular dilation (IPVD). The aim of this study was to determine the evidence of IPVD in a cohort of pediatric patients with CLD pre- and post-liver transplantation (LT). Material and methods. All pediatric patients with CLD listed for LT were studied. Pulse oxygen saturation (SpO2), technetium-99m–labeled macroaggregated albumin (99mTc- MAA) perfusion scan (positive test: uptake of the ≥ 6% in the brain), and echocardiography with saline bubble test (SBT) were performed. SBT was re-evaluated at 3-6 months after LT. Grading of SBT included grade 0 (no bubble), I (1-9 bubbles), grade II (10-20 bubbles), and grade III (› 20 bubbles). Results. Eighteen patients, median age 22.5 months (8-108), were enrolled. Most had biliary atresia (77.8%). Pre-LT, all patients had SpO2 of 100% and none had positive 99mTc- MAA perfusion scan. Two patients (11%) had negative SBT (grade 0), 1 (5.5%) had grade I, 3 (16.5%) had grade II, and 12 (67%) had grade III, respectively. Post-LT SBT became negative in all survivors (n = 16), (p = 0.0001). Conclusions. Most cirrhotic children in this cohort study had evidence of IPVD by positive SBT. However, none of these met the criteria for diagnosis of HPS. This evidence of IPVD subsided after LT.


REFERENCES

  1. Nusrat S, Khan MS, Fazili J, Madhoun MF. Cirrhosis and its complications: Evidence based treatment. World J Gastroenterol 2014; 20: 5442-60.

  2. Sussman NL, Kochar R, Fallon MB. Pulmonary complications in cirrhosis. Curr Opin Organ Transplant 2011; 16: 281-8.

  3. Krowka MJ, Cortese DA. Hepatopulmonary syndrome. Chest 1990; 98: 1053-4.

  4. Martinez GP, Barbera JA, Visa J, Rimola A, Pare JC, Roca J, Navasa M, et al. Hepatopulmonary syndrome in candidates for liver transplantation. J Hepatology 2001; 34: 651-7.

  5. Schenk P, Fuhrmann V, Madl C, Funk G, Lehr S, Kandel O, Muller C. Hepatopulmonary syndrome: Prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002; 51: 853-9.

  6. Noli K, Solomon M, Golding F, Charron M, Ling SC. Prevalence of hepatopulmonary syndrome in children. Pediatrics 2008; 121: e522-e527.

  7. Lange PA, Stoller JK. The hepatopulmonary syndrome. Effect of liver transplantation. Clin Chest Med 1996; 17: 115-23.

  8. Schneider BL, Suchy FJ, Emre S. National and regional analysis of exceptions to the pediatric end-stage liver disease scoring system (2003-2004). Liver Transpl 2006; 12: 40-5.

  9. Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995; 109: 1283-8.

  10. Krowka MJ, Tajik AJ, Dickson ER, Wiesner RH, Cortese DA. Intrapulmonary vascular dilatations (ipvd) in liver transplant candidates. Screening by two-dimensional contrast-enhanced echocardiography. Chest 1990; 97: 1165-70.

  11. Gudavalli A, Kalaria VG, Chen X, Schwarz KQ. Intrapulmonary arteriovenous shunt: Diagnosis by saline contrast bubbles in the pulmonary veins. J Am Soc Echocardiogr 2002; 15: 1012-14.

  12. Lao AY, Sharma VK, Tsivgoulis G, Frey JL, Malkoff MD, Navrro JC, Alexandrov AV. Detection of right-to-left shunts: Comparison between the international consensus and spencer logarithmic scale criteria. J Neruroimaging 2008; 18: 402-6.

  13. Wade OL, Bishop JM. Cardiac output and regional blood flow. Oxford, England: Blackwell Scientific; 1962.

  14. Varghese J, Ilias-basha H, Dhanasekaran R, Singh S, Venkataraman J. Hepatopulmonary syndrome - past to present. Ann Hepatology 2007; 6: 135-42.

  15. de Macedo LG, Lopes EP. Hepatopulmonary syndrome: An update. Sao Paulo Med J 2009; 127: 223-30.

  16. Cremon G, Higenbottam TW, Mayoral V, Alexander G, Demoncheaux E, Borland C, Roe P, et al. Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome. Eur Resp J 1995; 8: 1883-5.

  17. Porres-Aguilar M, Altamirano JT, Torre-Delgadillo A, Charlton MR, Duarte-Rojo A. Portopulmonary hypertension and hepatopulmonary syndrome: A clinician-oriented overview. Eur Resp Review 2012; 21: 223-33.

  18. Castro M, Krowka MJ. Hepatopulmonary syndrome: A pulmonary vascular complication of liver disease. Clin Chest Med 1996; 17: 35-48.

  19. Shub C, Tajik AJ, Seward JB, Dines DE. Detecting intrapulmonary right-to-left shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas. Mayo Clin Proc 1976; 51: 81-4.

  20. Khan AN, Al-Jahdali H, Abdullah K, Irion KL, Sabih Q, Gouda A. Pulmonary vascular complications of chronic liver disease: Pathophysiology, imaging, and treatment. Ann Thorac Med 2011; 6: 57-65.

  21. El-Shabrawi MH, Omran S, Wageeh S, Isa M, Okasha S, Mohsen NA, Zekry O, et al. (99m)technetium-macroaggregated albumin perfusion lung scan versus contrast enhanced echocardiography in the diagnosis of the hepatopulmonary syndrome in children with chronic liver disease. Eur J Gastroenterol Hepatol 2010; 22: 1006-12.

  22. Abrams GA, Nanda NC, Dubovsky EV, Krowka MJ, Fallon MB. Use of macroaggregated albumin lung perfusion scan to diagnose hepatopulmonary syndrome: A new approach. Gastroenterology 1998; 114: 305-10.

  23. Krowka MJ. Hepatopulmonary syndrome and portopulmonary hypertension: Distinctions and dilemmas. Hepatology 1997; 25: 1282-4.

  24. Rodriguez-Roisin R, Krowka MJ, Herve P, Fallon MB, Committee ERSTFP-HVDS. Pulmonary-hepatic vascular disorders (phd). Eur Resp J 2004; 24: 861-80.

  25. Fallon MB, Abrams GA. Pulmonary dysfunction in chronic liver disease. Hepatology 2000; 32: 859-65.

  26. Arguedas MR, Abrams GA, Krowka MJ, Fallon MB. Prospective evaluation of outcomes and predictors of mortality in patients with hepatopulmonary syndrome undergoing liver transplantation. Hepatology 2003; 37: 192-7.

  27. Hervé P, Lebrec D, Brenot F, Simonneau G, Humbert M, Sitbon O, Duroux P. Pulmonary vascular disorders in portal hypertension. Eur Respir J 1998; 11: 1153-66.




2020     |     www.medigraphic.com