Document Detail


Short-term effects of transjugular intrahepatic shunt on cardiac function assessed by cardiac MRI: preliminary results.
MedLine Citation:
PMID:  19730936     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The purpose of this study was to assess shortterm effects of transjugular intrahepatic shunt (TIPS) on cardiac function with cardiac magnetic resonance imaging (MRI) in patients with liver cirrhosis. Eleven patients (six males and five females) with intractable esophageal varices or refractory ascites were imaged with MRI at 1.5 T prior to, within 24 h after, and 4-6 months after TIPS creation (n = 5). Invasive pressures were registered during TIPS creation. MRI consisted of a stack of contiguous slices as well as phase contrast images at all four valve planes and perpendicular to the portal vein. Imaging data were analyzed through time-volume curves and first derivatives. The portoatrial pressure gradient decreased from 19.8 + or = 2.3 to 6.6 + or = 2.3, accompanied by a nearly two fold increase in central pressures and pulmonary capillary wedge pressure immediately after TIPS creation. Left and right end diastolic volumes and stroke volumes increased by 11, 13, and 24%, respectively (p\0.001), but dropped back to baseline at follow-up. End systolic volumes remained unchanged. E/A ratios remained within normal range. During follow-up the left ventricular mass was larger than baseline values in all patients, with an average increase of 7.9 g (p\0.001). In conclusion, the increased volume load shunted to the heart after TIPS creation transiently exceeded the preload reserve of the right and left ventricle, leading to significantly increased pulmonary wedge pressures and persistent enlargement of the left and right atria. Normalization of cardiac dimensions was observed after months together with mild left ventricular hypertrophy.
Authors:
A Kovács; M Schepke; J Heller; H H Schild; S Flacke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  33     ISSN:  1432-086X     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-07-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  290-6     Citation Subset:  IM    
Affiliation:
Department of Radiology, University of Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany. Attila.Kovacs@ukb.uni-bonn.de
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MeSH Terms
Descriptor/Qualifier:
Aged
Ascites / complications,  diagnosis,  surgery
Cardiac Output
Cardiomyopathies / diagnosis*,  etiology,  mortality,  surgery*
Cohort Studies
Esophageal and Gastric Varices / complications,  diagnosis,  surgery
Female
Follow-Up Studies
Heart Function Tests
Humans
Liver Cirrhosis / complications*,  diagnosis,  mortality,  surgery*
Magnetic Resonance Imaging*
Male
Middle Aged
Palliative Care / methods
Portasystemic Shunt, Transjugular Intrahepatic / methods*
Probability
Prospective Studies
Pulmonary Wedge Pressure
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Stroke Volume
Survival Rate
Time Factors
Treatment Outcome

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


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