Clinical and haemodynamic aspects of hepatopulmonary syndrome in Indian patients with cirrhosis.
BACKGROUND
Hepatopulmonary syndrome consists of the triad of hepatic dysfunction and/or portal hypertension, intrapulmonary vascular dilatation and hypoxaemia, in the absence of detectable primary cardiopulmonary diseases. In the present study, we examined the frequency of hepatopulmonary syndrome among Indian patients with cirrhosis, and studied clinical predictors and pulmonary haemodynamic alterations.


METHODS
Forty-five patients with cirrhosis and no cardiopulmonary diseases were investigated by air-contrast echocardiography. Where patients were positive, arterial blood gas analysis was carried out. Positive contrast echocardiography with PO2 < 70 mmHg confirmed the diagnosis of hepatopulmonary syndrome. Three cases with the syndrome and 24 without were assessed for haemodynamic status by hepatic and pulmonary catheterization.


RESULTS
Four of 45 cases of cirrhosis (8.9%) had positive contrast echocardiographies, including three (6.7%) with hepatopulmonary syndrome and one 'subclinical' case (positive contrast echocardiography without hypoxaemia). Under haemodynamic study, the mean pulmonary arterial and pulmonary capillary wedge pressures appeared to be lower among those patients with hepatopulmonary syndrome.


CONCLUSIONS
In this small study, the frequency of hepatopulmonary syndrome was relatively low (6.7%). Cyanosis was the only reliable clinical indicator, and there was no clear relationship with the severity of cirrhosis by Child's grading.
De
B K
BK
Department of Medicine, Institute of Post-Graduate Medical Education and Research, Calcutta, India. binaykde@apexmail.com
Sen
S
S
Biswas
P K
PK
Biswas
J
J
Maity
A K
AK
D000293:Adolescent; D000328:Adult; D000368:Aged; D002302:Cardiac Output; D002406:Catheterization, Peripheral; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006499:Hepatic Artery; D020065:Hepatopulmonary Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008102:Liver Circulation; D008103:Liver Cirrhosis / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011651:Pulmonary Artery; D011669:Pulmonary Wedge Pressure; D012189:Retrospective Studies; D014655:Vascular Resistance