Liver Injury, Chronic/physiopathology

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Editorial

Transesophageal Echocardiogram with Contrast in Pulmonary Intravascular Dilation in Hepatosplenic Schistosomiasis

The Hepatopulmonary syndrome (HPS) is defined as a defect in arterial oxygenation induced by intrapulmonary vascular dilation (IPVD) associated with liver disease. The vascular component includes diffuse or localized capillary dilation and, less commonly, pulmonary arteriovenous malformations.

A sensitive approach for the early detection of altered arterial oxygenation is the calculation of the alveolar-arterial oxygen pressure difference (PA-aO₂). This difference can be elevated before arterial oxygen pressure becomes abnormal. At sea level, PA-aO₂ ≥ 15 mmHg is considered abnormal (it changes to 20 mmHg in individuals over 64 years).

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Original Article

Value of Contrast Transesophageal Echocardiography in the Detection of Intrapulmonary Vascular Dilatations in Hepatosplenic Schistosomiasis

Aparecida de Gouvea et al. Claudio Henrique Fischer Jaquelina Sonoe Ota Arakaki Frederico José Mancuso … Paulo Brant Valdir Ambrósio Moisés Orlando Campos Filho

Abstract

Background:

Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis.

Objective:

To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS.

Methods:

cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student’s t-test and the chi-square test (p < 0.05).

Results:

cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09).

Conclusion:

In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.