Hepatopulmonary syndrome
https://doi.org/10.23873/2074-0506-2009-0-2-5-8
Abstract
The purpose of this paper is to analyze the data available in the literature on the problems associated with the identification of the hepatopulmonary syndrome (HPS), its diagnosis, pathogenesis, clinical features, and possible treatment options. According to the current literature, HPS is a complication of liver diseases, which leads to impaired lung perfusion and decreased blood oxygenation. Recognition of this syndrome requires that there should be a triad of the following signs: chronic liver disease, dilated intrapulmonary vessels, and lower arterial blood oxygenation. Today investigators' views of the causes and pathogenesis of dilated pulmonary vessels and abnormal blood gas composition differ in HPS. To date, its clear diagnostic algorithm and treatment policy for patients with HPS have not been elaborated.
About the Authors
V. T. Ivashkin
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
M. A. Morozova
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
M. V. Mayevskaya
I.M. Sechenov Moscow Medical Academy
Russian Federation
Russian Federation
References
1. Lange P.A., Stoller J.K. The hepatopulmonary syndrome. Ann Intern Med 1995;122:521—9.
2. Rodriguez-Roisin R., Agusti A.G., Roca J. The hepatopulmonary syndrome: new name, old complexities. Thorax 1992;47:897—902.
3. Rodriguez-Roisin R., Krowka M.J., Herve P., Fallon M.B. On behalf of the ERS Task Force Pulmonary-Hepatic Vascular Disorders Scientific Committee ERS Task Force PHD Scientific Committee. Pulmonary-Hepatic vascular Disorders (PHD). Eur Respir J 2004;24:861—80.
4. Schenk P., Fuhrmann V., Madl C. et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002;51:853—9.
5. Harris E., Kenyon A., Nisbet H. et al. The normal alveolar-arterial oxygen-tension gradient in man. Clin Sci Mol Med 1974;46:89—104.
6. Ивашкин В.Т. Болезни печени и желчевыводящих путей. М.: ООО «Издательский дом «М-Вести», 2002. с. 134—5.
7. Майер К.-П. Гепатит и последствия гепатита: Практич. рук. Пер. с нем. 2-е изд., перераб. и доп. М.: ГЕОТАР-МЕД, 2004. с. 574—6.
8. Abrams G., Nanda N., Dubovsky E. et al. Use of macroaggregated albumin lung perfusion scan to diagnose hepatopulmonary syndrome: a new approach. Gastroenterology 1998:114.
9. Martinez G., Barbera J., Navasa M. et al. Hepatopulmonary syndrome associated with cardiorespiratory disease. J Hepatol 1999;30:882—9.
10. Dimand R.J., Heyman M.B., Bass N.M. et al. Hepatopulmonary syndrome: response to hepatic transplantation. Hepatology 1991;141:55 [abstract].
11. Abrams G., Fallon M. The Hepatopulmonary syndrome. Clin.Liver Dis 1997;1:185—200.
12. Binay K., Sen S., Biswas P.K. et al. Hepatopulmonary syndrome in inferior vena cava obstruction responding to cavoplasty. Gastroenterology 2000;118:192—6.
13. Gupta D., Vijaya D.R., Gupta R. et al. Prevalence of hepatopulmonary syndrome in cirrhosis and extrahepatic portal venous obstruction. Am J Gastroenterol 2001;96:3395—9.
14. Regev A., Yeshurun M., Rodriguez M. et al. Transient hepatopulmonary syndrome in a patient with acute hepatitis A. J Viral Hep 2001;8:83—6.
15. Teuber G., Teupe C., Dietrich C. et al. Pulmonary dysfunction in non-cirrhotic patients with chronic viral hepatitis. Eur J Intern Med 2002;13:311—8.
16. Naeije R. Hepatopulmonary syndrome and portopulmonary hypertension. Swiss Med Wkly 2003;133(11—12):163—9.
17. Gomez F., Barbera J., Roca J. et al. Effects of nebulized NG-nitro-L-arginine methyl ester in patients with hepatopulmonary syndrome. Hepatology 2006;43:1084—91.
18. Cremona G., Higenbottam T.W., Mayoral V. et al. Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome. Eur Respir J 1995;8:1883—5.
19. Rolla G., Brussino L., Colagrande P. et al. Exhaled nitric oxide and oxygenation abnormalities in hepatic cirrhosis. Hepatology 1997;26:842—7.
20. Rolla G., Brussino L., Colagrande P. Exhaled nitric oxide and impaired oxygenation in cirrhotic patients before and after liver transplantation. Ann Intern Med 1998;129:375—8.
21. Hui-Ying Zhang, De-Wu Han, Ai-Rong Su et al. Intestinal endotoxemia plays a central role in development of hepatopulmonary syndrome in a cirrhotic rat model induced by multiple pathogenic factors. World J Gastroenterol 2007;13(47):6385—95.
22. Nunes H., Lebrec D., Mazmanian M. et al. Role of nitric oxide in hepatopulmonary syndrome in cirrhotic rats. Am J Respir Crit Care Med 2001;164:879—85.
23. Carter E.P., Hartsfield C.L., Miyazono M. et al. Regulation of heme oxygenase-1 by nitric oxide during hepatopulmonary syndrome. Am J Physiol Lung Cell Mol Physiol 2002;283:346—53.
24. Бурневич Э., Елизарова С. Печеночно-легочный синдром. М.: ООО «Издательский дом «Русский врач». 2001—2008.
25. Rabiller A., Nunes H., Lebrec D. et al. Prevention of gram-negative translocation reduces the severity of hepatopulmonary syndrome. Am J Respir Crit Care Med 2002;166:514—7.
26. Sztrymf B., Rabiller A., Nunes H. et al. Prevention of hepatopulmonary syndrome by pentoxifylline in cirrhotic rats. Eur Respir J 2004;23:752—8.
27. Zhang J., Ling Y., Luo B. et al. Analysis of pulmonary heme oxygenase-1 and nitric oxide synthase alterations in experimental hepatopulmonary syndrome. Gastroenterology 2003;125:1441—51.
28. Hughes J.M.B. The hepatopulmonary syndrome: NO way out? Eur Respir J 2005;25:211—2.
29. Abrams G.A., Jaffe C.C., Hoffer P.B. et al. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995;109:1283—8.
30. Ryu J.K., Oh J.H. Hepatopulmonary syndrome: angiography and therapeutic embolization. Clin Imaging 2003;27(2): 97—100.
31. Lima B.L., Franca A.V., Pazin-Filho A. et al. Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 2004;79(1):42—8.
32. Anel R.M., Sheagren J.N. Novel presentation and approach to management of hepatopulmonary syndrome with use of antimicrobial agents. Clin Infect Dis 2001;32:131—6.
33. Boyer T.D. Transjugular intrahepatic portosystemic shunt: current status. Gastroenterology 2003;124(6):1700—10.
34. Chevallier P., Novelli L., Motamedi J.-P. et al. Hepatopulmonary syndrome successfully treated with transjugular intrahepatic portosystemic shunt. A three-year follow-up. J Vasc Intervent Radiol 2004;15:647—8.
35. Ward A., Clissold S. Pentoxifylline. A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic efficacy. Drugs 1987;34:50—97.
Review
For citations:
Ivashkin V.T., Morozova M.A., Mayevskaya M.V. Hepatopulmonary syndrome. Transplantologiya. The Russian Journal of Transplantation. 2009;(2):5-8. (In Russ.) https://doi.org/10.23873/2074-0506-2009-0-2-5-8
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