title: Pulmonary blood transit time and impaired arterial oxygenation in patients with chronic liver disease.
abstract: BACKGROUND
  Contrast-enhanced echocardiography (CEE) using agitated saline can detect intrapulmonary vasodilatation (IPVD) in patients with hepatopulmonary syndrome (HPS). We estimated the pulmonary transit time of erythrocytes (PTT) by CEE, using microbubbles, and studied its relationship to arterial oxygenation in chronic liver disease.
  
  
  METHODS
  Sixteen patients with chronic liver disease and seven healthy subjects were studied. PTT was defined as the time between opacification of the right atrium and left atrium on CEE, using human serum albumin-air microbubble complexes with a mean diameter of 4 microm (Albunex). IPVD was detected by CEE with agitated saline. Arterial blood gases were analyzed with patients in the supine position, and while they were seated. Cardiac output (CO) was determined by Doppler echocardiography.
  
  
  RESULTS
  The mean PTT value for all of the patients was 4.0 +/- 1.4 s. One of the 3 patients who showed IPVD was normoxemic. Mild orthodeoxia was observed in the patients with abnormal alveolar-arterial oxygen difference (A-aDO2) values (>15 mmHg), but not in those with normal A-aDO2 values, or in the healthy subjects. PTT was correlated with PaO2 (r = 0.52; P < 0.05; n = 16) and A-aDO2 (r = -0.54; P < 0.05; n = 16) in the seated position. CO was significantly correlated with PTT (r = -0.62; P < 0.05; n = 15), but not with PaO2 and A-aDO2, in both positions.
  
  
  CONCLUSIONS
  PTT may be a useful parameter for evaluating arterial oxygenation in patients with chronic liver disease with early HPS.
authors.affiliation: First Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Katsuta
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Honma
authors.forename: Xue-Jun
authors.initials: XJ
authors.lastname: Zhang
authors.forename: Masaru
authors.initials: M
authors.lastname: Ohsuga
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Komeichi
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Katoh
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miura
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Satomura
authors.forename: Takumi
authors.initials: T
authors.lastname: Aramaki
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000328:Adult; D000368:Aged; D000472:Alkalosis, Respiratory / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D001784:Blood Gas Analysis; D002302:Cardiac Output / Q000502:physiology; D002908:Chronic Disease; D004452:Echocardiography; D004912:Erythrocytes / Q000000981:diagnostic imaging / Q000378:metabolism; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D006801:Humans; D016857:Hypocapnia / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011187:Posture / Q000502:physiology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000503:physiopathology*; D011652:Pulmonary Circulation / Q000502:physiology*; D013997:Time Factors; D014664:Vasodilation / Q000502:physiology
chemical_list: D010100:Oxygen