Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension.
The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni.



The University of São Paulo Medical School, Brazil; Public Practice.



Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1-distal splenorenal shunt (DSRS, n = 13) and group 2-esophagogastric devascularization and splenectomy (EGDS, n = 15).



The cardiac output (5.08 ± 0.91 L/min) and systolic volume (60.1 ± 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05).



The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Orlando Luis de Andrade
OL
Santarém
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Roberto de
Rd
Cleva
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Flávia Megumi
FM
Sasaya
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Marianna Siqueira de
MS
Assumpção
Department of Radiology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Meive Santos
MS
Furtado
Department of Radiology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Alfonso
A
Julio Guedes Barbato
Department of Gastroenterology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil.
Paulo
P
Herman
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004106:Dilatation; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged