Arterial oxygenation associated with portopulmonary hypertension

Karen L. Swanson, Michael Joseph Krowka

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Study objectives: To characterize arterial oxygenation in patients referred to Mayo Clinic for liver transplantation with a diagnosis of portopulmonary hypertension (portoPH). Design: Prospective study. Setting: Liver transplantation program and pulmonary hypertension clinic in a tertiary referral center. Participants: Twenty consecutive patients with abnormal pulmonary hemodynamics documented by right-heart catheterization (mean pulmonary artery pressure [MPAP] ≥ 25 mm Hg, pulmonary vascular resistance [PVR] ≥ 120 dyne·s·cm-5, and pulmonary capillary wedge pressure [PCWP] ≤ 15 mm Hg). Liver transplant candidates with normal pulmonary hemodynamics via screening Doppler echocardiography (n = 40) served as control subjects. A subgroup of patients underwent postural and inspired 100% oxygen blood gas analysis, contrast echocardiography, and technetium-labeled macroaggregated albumin (99mTcMAA) lung/brain scanning to identify and quantitate the degree of intracardiac or intrapulmonary shunting. Measurements and results: portoPH was moderate to severe (MPAP ≥ 35 mm Hg) in 18 of 20 patients (90%). Arterial-alveolar oxygen pressure gradient (P[A-a]O2) was abnormal (≥ 20 mm Hg) in 16 of 20 patients (80%). PaO2 was abnormal (≤ 70 mm Hg) in 3 of 20 patients (15%). PaO2 was significantly less and P(A-a)O2 was significantly greater compared to control subjects (p ≤ 0.001). All patients had normal 99mTcMAA brain uptake (≤ 6%) and negative transthoracic contrast echocardiographic findings. No significant correlations were found between oxygenation and hemodynamic variables (MPAP, PVR, PVR index, and transpulmonary gradient). Conclusions: Arterial oxygenation associated with portoPH was frequently abnormal and significantly worse when compared to patients with normal pulmonary hemodynamics by Doppler echocardiography. Hypoxemia, as measured by PaO2 and P(A-a)O2, was usually mild even in the setting of moderate-to-severe portoPH.

Original languageEnglish (US)
Pages (from-to)1869-1875
Number of pages7
JournalChest
Volume121
Issue number6
DOIs
StatePublished - 2002

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Hypertension
Hemodynamics
Vascular Resistance
Pulmonary Artery
Pressure
Lung
Doppler Echocardiography
Liver Transplantation
Oxygen
Blood Gas Analysis
Pulmonary Wedge Pressure
Technetium
Brain
Cardiac Catheterization
Pulmonary Hypertension
Tertiary Care Centers
Echocardiography
Albumins
Prospective Studies
Transplants

Keywords

  • Liver cirrhosis
  • Lung scanning
  • Portal hypertension
  • Pulmonary hemodynamics
  • Pulmonary hypertension
  • Shunt

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Arterial oxygenation associated with portopulmonary hypertension. / Swanson, Karen L.; Krowka, Michael Joseph.

In: Chest, Vol. 121, No. 6, 2002, p. 1869-1875.

Research output: Contribution to journalArticle

Swanson, Karen L. ; Krowka, Michael Joseph. / Arterial oxygenation associated with portopulmonary hypertension. In: Chest. 2002 ; Vol. 121, No. 6. pp. 1869-1875.
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abstract = "Study objectives: To characterize arterial oxygenation in patients referred to Mayo Clinic for liver transplantation with a diagnosis of portopulmonary hypertension (portoPH). Design: Prospective study. Setting: Liver transplantation program and pulmonary hypertension clinic in a tertiary referral center. Participants: Twenty consecutive patients with abnormal pulmonary hemodynamics documented by right-heart catheterization (mean pulmonary artery pressure [MPAP] ≥ 25 mm Hg, pulmonary vascular resistance [PVR] ≥ 120 dyne·s·cm-5, and pulmonary capillary wedge pressure [PCWP] ≤ 15 mm Hg). Liver transplant candidates with normal pulmonary hemodynamics via screening Doppler echocardiography (n = 40) served as control subjects. A subgroup of patients underwent postural and inspired 100{\%} oxygen blood gas analysis, contrast echocardiography, and technetium-labeled macroaggregated albumin (99mTcMAA) lung/brain scanning to identify and quantitate the degree of intracardiac or intrapulmonary shunting. Measurements and results: portoPH was moderate to severe (MPAP ≥ 35 mm Hg) in 18 of 20 patients (90{\%}). Arterial-alveolar oxygen pressure gradient (P[A-a]O2) was abnormal (≥ 20 mm Hg) in 16 of 20 patients (80{\%}). PaO2 was abnormal (≤ 70 mm Hg) in 3 of 20 patients (15{\%}). PaO2 was significantly less and P(A-a)O2 was significantly greater compared to control subjects (p ≤ 0.001). All patients had normal 99mTcMAA brain uptake (≤ 6{\%}) and negative transthoracic contrast echocardiographic findings. No significant correlations were found between oxygenation and hemodynamic variables (MPAP, PVR, PVR index, and transpulmonary gradient). Conclusions: Arterial oxygenation associated with portoPH was frequently abnormal and significantly worse when compared to patients with normal pulmonary hemodynamics by Doppler echocardiography. Hypoxemia, as measured by PaO2 and P(A-a)O2, was usually mild even in the setting of moderate-to-severe portoPH.",
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AB - Study objectives: To characterize arterial oxygenation in patients referred to Mayo Clinic for liver transplantation with a diagnosis of portopulmonary hypertension (portoPH). Design: Prospective study. Setting: Liver transplantation program and pulmonary hypertension clinic in a tertiary referral center. Participants: Twenty consecutive patients with abnormal pulmonary hemodynamics documented by right-heart catheterization (mean pulmonary artery pressure [MPAP] ≥ 25 mm Hg, pulmonary vascular resistance [PVR] ≥ 120 dyne·s·cm-5, and pulmonary capillary wedge pressure [PCWP] ≤ 15 mm Hg). Liver transplant candidates with normal pulmonary hemodynamics via screening Doppler echocardiography (n = 40) served as control subjects. A subgroup of patients underwent postural and inspired 100% oxygen blood gas analysis, contrast echocardiography, and technetium-labeled macroaggregated albumin (99mTcMAA) lung/brain scanning to identify and quantitate the degree of intracardiac or intrapulmonary shunting. Measurements and results: portoPH was moderate to severe (MPAP ≥ 35 mm Hg) in 18 of 20 patients (90%). Arterial-alveolar oxygen pressure gradient (P[A-a]O2) was abnormal (≥ 20 mm Hg) in 16 of 20 patients (80%). PaO2 was abnormal (≤ 70 mm Hg) in 3 of 20 patients (15%). PaO2 was significantly less and P(A-a)O2 was significantly greater compared to control subjects (p ≤ 0.001). All patients had normal 99mTcMAA brain uptake (≤ 6%) and negative transthoracic contrast echocardiographic findings. No significant correlations were found between oxygenation and hemodynamic variables (MPAP, PVR, PVR index, and transpulmonary gradient). Conclusions: Arterial oxygenation associated with portoPH was frequently abnormal and significantly worse when compared to patients with normal pulmonary hemodynamics by Doppler echocardiography. Hypoxemia, as measured by PaO2 and P(A-a)O2, was usually mild even in the setting of moderate-to-severe portoPH.

KW - Liver cirrhosis

KW - Lung scanning

KW - Portal hypertension

KW - Pulmonary hemodynamics

KW - Pulmonary hypertension

KW - Shunt

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