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2019, Number 1

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Rev Hosp Jua Mex 2019; 86 (1)

Hepatopulmonary syndrome

Velasco-Santiago YM, Mejía-Loza SMI, López-Gómez LM, Fernández-Martínez NC

Language: Spanish
References: 23
Page: 39-45
PDF size: 330.81 Kb.


ABSTRACT

Hepatopulmonary syndrome (HPS) is defined as a defect in arterial oxygenation due to the presence of intrapulmonary vascular dilatations in the context of liver disease. In cirrhosis of the liver it has a prevalence of 15-23%. The diagnostic criteria proposed by the European Respiratory Society in 2004 are the presence of liver disease and/or hypertension portal, an alveolar-arterial oxygen gradient (A-aO2) ≥ 15 mmHg or in patients › 64 years ≥ 20 mmHg study of arterial gasometry and the demonstration of intrapulmonary venous derivatives (IPVD) by contrast echocardiography. The HPS has been associated with portal hypertension, with or without cirrhosis, and is also described in patients with extrahepatic obstruction, acute or chronic inflammatory liver disease (hepatitis A, fulminant, ischemic hepatitis) and Budd-Chiari syndrome, indicating that neither dysfunction in hepatic synthesis nor portal hypertension are necessary for its development. The recognition of the development of pulmonary vascular alterations, whether it is dilation of the microvasculature (HPS) or arteriolar vasoconstriction (portopulmonary hypertension), indicates that liver disease can generate unique changes in the pulmonary vasculature which have an impact on the quality of life and survival of patients.


REFERENCES

  1. The European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with descompensated cirrhosis. J Hepatol 2018; 69: 406-60.

  2. Grace J, Angus P. Hepatopulmonary syndrome: Update on recent advances in pathophysiology, investigation, and treatment. Journal of Gastroenterology and Hepatology 2013; 28: 213-9.

  3. Kennedy T, Knudson R. Exercise-aggravated hypoxemia and orthodeoxia in cirrhosis. Chest. 1977; 72(3): 305-9.

  4. Raevens S, Geerts A, Van Steenkiste C, et al. Hepatopulmonary syndrome and portopulmonary hypertension: recent knowledge in pathogenesis and overview of clinical assessment. Liver Int 2015; 35: 1646-60.

  5. Machicao M, Balakrishnan M, Fallon M. Pulmonary complications in chronic liver disease. Hepatology 2014; 59: 1627-37.

  6. Porres M, Altamirano J, Torre A, et al. Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview. Eur Respir Rev 2012; 21(125): 223-33.

  7. Shah V. Molecular mechanisms in the pathogenesis of cirrhotic portal hypertension: focus on nitric oxide. Journal of Gastroenterology and Hepatology 2004; 19: S145-9.

  8. Zhang J, Yang W, et al. The role of CX(3)CL1/CX(3)CR1 in pulmonary angiogenesis an intravascular monocite accumulation in rat experimental hepatopulmonary syndrome. Am J Pathol 2014; 184: 1706-14.

  9. Iyer V, Swanson K, Cartin R, et al. Hepatopulmonary syndrome: favorable outcomes in the MELD exception era. Hepatology 2013; 57: 2427-35.

  10. Salazar A, Herrera J, Toledo J, et al. Síndrome hepatopulmonar: situación clínica en un hospital de tercer nivel en Puebla, México. Neumol Cir Tórax 2016; 75(1): 18-24.

  11. Grilo I, Pascasio JM. Hepatopulmonary syndrome: what we know and what we would like to know. World J Gastroenterol 2016; 22(25): 5728-41.

  12. Fallon M, Abrams G. Pulmonary dysfunction in chronic liver disease. Hepatology 2000; 32(4): 859-65.

  13. Moller S, Henriksen J. Cardiovascular complications of cirrhosis. Gut 2008; 57: 268-78.

  14. Schenk P, Fuhrmann V, Madl C, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002; 51: 853-9.

  15. Zagolín M, Medel JN, Valera J. Síndrome hepatopulmonar e hipertensión portopulmonar: dos entidades a diferenciar. Rev Chil Enf Respir 2008; 24: 291-303.

  16. Kamath P. Portopulmonary hypertension and hepatopulmonary syndrome. Journal of Gastroenterology and Hepatology 2002; 17: S253-5.

  17. Krowka M. Hepatopulmonary syndromes. Gut 2000; 46: 1-4.

  18. Abrams GA, Fallon MB. Treatment of hepatopulmonary syndrome with Allium sativum I (garlic): a pilot trial. J Clin Gastroenterol 1998; 27: 232-5.

  19. Sani MN, Kianifar HR, Kianee A, et al. Effect of oral garlic on arterial oxygen pressure in children with HPS. World J Gastroenterol 2006; 12: 2427-31.

  20. Krowka M, Wiesner R, Heimbach J. Pulmonary contraindications, indications and MELD exceptions for liver transplantation: A contemporary view and look forward. Journal of Hepatology 2013; 59: 367-74.

  21. Goldberg D, Krok K, Batra S, et al. Impact of the hepatopulmonary syndrome MELD exception policy on outcomes of patients after liver transplantation: an analysis of the UNOS database. Gastroenterology 2014; 146: 1256-65.

  22. Tanikella R, Fallon M. Hepatopulmonary syndrome and liver transplantation: who, when, and where? Hepatology 2013; 57(6): 2097-9.

  23. Swanson KL, Wiesner RH, Krowka MJ. Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology 2005; 41: 1122-9.




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