Prevalence of pulmonary hypertension in patients with hepatosplenic Mansonic schistosomiasis--prospective study.
OBJECTIVE
Thirty-four patients with portal hypertension and previous history of esophageal varices hemorrhage due to hepatosplenic Mansonic schistosomiasis were prospectively studied.


METHODS
All patients underwent invasive hemodynamic monitoring with introduction of a pulmonary artery catheter. Hemodynamic evaluation was characterized by an increased cardiac index (4.90 +/- 1.27 L/min/m2) associated to a decrease in systemic vascular resistance index (1461 +/- 443.04 dynes.sec/cm5.m2).


RESULTS
Mean pulmonary artery pressure (17.97 +/- 6.97 mmHg) and right atrial pressure (7.65 +/- 3.67 mmHg) were increased while pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dynes.sec/cm5.m2). Twenty-four patients (70.5%) presented pulmonary hypertension (mean pulmonary artery pressure > 15 mmHg); in fifteen (44.1%) pulmonary pressure was between 15 and 20 mmHg, in three between 20 and 25 mmHg and, in four patients, pulmonary pressure was higher than 25 mmHg.


CONCLUSIONS
In conclusion, pulmonary hypertension is a frequent complication in patients with portal hypertension due to hepatosplenic Mansonic schistosomiasis and, in 20.6% of the cases, it can be considered as moderate or severe. Our results suggest that shunt surgeries, which can aggravate pulmonary hypertension, should be employed very cautiously in the treatment of schistosomal portal hypertension.
de Cleva
Roberto
R
Gastroenterology Department, Hospital das Clínicas, University of Sao Paulo Medical School (FMUSP), Brazil. roberto.cleva@honet.usp.br
Herman
Paulo
P
Pugliese
Vincenzo
V
Zilberstein
Bruno
B
Saad
William Abrão
WA
Rodrigues
Joaquim Jose Gama
JJ
Laudanna
Antonio Atílio
AA
D000293:Adolescent; D000328:Adult; D001938:Brazil; D002407:Catheterization, Swan-Ganz; D003430:Cross-Sectional Studies; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008109:Liver Diseases, Parasitic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012555:Schistosomiasis mansoni / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D013158:Splenic Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology