Document Detail


Recent advances in hepatopulmonary syndrome.
MedLine Citation:
PMID:  16323392     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hepatopulmonary syndrome is defined as the clinical triad of advanced liver disease, arterial deoxygenation and intrapulmonary vascular dilatation. Its pathogenesis is not completely understood. Excessive pulmonary nitric oxide production seems to be one of the factors that contribute to the intrapulmonary vascular dilatation. Other mediators such as endothelin-1 and the heme oxygenase-1/carbon monoxide system have recently been found to be important contributors. The major clinical manifestations are arterial hypoxemia, clubbed fingers and spider nevi. Orthodeoxia is the characteristic clinical feature. Contrast-enhanced echocardiography is the preferred screening test. 99mTechnetium macroaggregated albumin (Tc-99m MAA) lung perfusion scan can further specify the diagnosis of hepatopulmonary syndrome and quantify the magnitude of shunting. No clearly effective medical treatments have been found. Although liver transplantation seems feasible to reverse this situation, it is associated with increased postoperative morbidity and mortality. A preoperative arterial oxygen tension of 50 mmHg or less and Tc-99m MAA shunt fractions of 20% or more are strong predictors of postoperative mortality that can be used to stratify patients with better outcome.
Authors:
Ying-Wen Wang; Han-Chieh Lin
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of the Chinese Medical Association : JCMA     Volume:  68     ISSN:  1726-4901     ISO Abbreviation:  J Chin Med Assoc     Publication Date:  2005 Nov 
Date Detail:
Created Date:  2005-12-05     Completed Date:  2005-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101174817     Medline TA:  J Chin Med Assoc     Country:  China (Republic : 1949- )    
Other Details:
Languages:  eng     Pagination:  500-5     Citation Subset:  IM    
Affiliation:
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
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MeSH Terms
Descriptor/Qualifier:
Carbon Monoxide / metabolism
Echocardiography
Hepatopulmonary Syndrome / complications,  diagnosis*,  etiology,  therapy
Humans
Nitric Oxide / biosynthesis
Prognosis
Technetium Tc 99m Aggregated Albumin / diagnostic use
Chemical
Reg. No./Substance:
0/Technetium Tc 99m Aggregated Albumin; 10102-43-9/Nitric Oxide; 630-08-0/Carbon Monoxide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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