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[The hepatopulmonary syndrome]
V Gautier-Brun1, I Beurton-Chataigner, P Manzoni
1Service d'Hépatologie et de Soins Intensifs Digestifs, CHRU Jean Minjoz, F25030 Besançon. valerie.brun7@libertysurf.fr
Presse Medicale (Paris, France : 1983)
|March 9, 2002
Summary
Hepatopulmonary syndrome (HPS) involves liver disease, low oxygen levels (hypoxemia), and widened pulmonary blood vessels. Liver transplant is the only effective treatment, though research continues for better therapies.
Area of Science:
- Cardiology
- Pulmonology
- Hepatology
Background:
- Hepatopulmonary syndrome (HPS) is characterized by chronic liver disease, hypoxemia, and pulmonary vasodilation.
- The underlying mechanisms of pulmonary vasodilation in HPS are complex and not fully understood, involving an imbalance of vasoactive mediators.
Purpose of the Study:
- To explore the pathophysiology, clinical manifestations, diagnostic approaches, and therapeutic options for hepatopulmonary syndrome.
Main Methods:
- Clinical assessment including platypnea and orthodeoxia.
- Diagnostic tests such as arterial blood gases, contract echocardiography, pulmonary perfusion scintigraphy, and pulmonary angiography.
- Evaluation of preliminary data on densitometry for detecting pulmonary vasodilation.
Main Results:
- Hypoxemia in HPS is attributed to ventilation-perfusion mismatch and diffusion-perfusion defects.
- Characteristic clinical signs include stellar angiomas, digital hippocratism, and signs of portal hypertension.
- Contract echocardiography is crucial for diagnosis, while pulmonary perfusion scintigraphy aids in prognosis.
Conclusions:
- Hepatic transplant (HT) is the definitive treatment for HPS.
- Intra-hepatic portal systemic shunts may serve as a bridge to HT or an alternative for select patients.
- Further research into HPS pathophysiology is needed to develop effective medical treatments.