Prevalence of spontaneous portosystemic shunts in patients with portopulmonary hypertension and effect on treatment

Jayant A. Talwalkar, Karen L. Swanson, Michael Joseph Krowka, James C. Andrews, Patrick Sequeira Kamath

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background & Aims: We documented the frequency of large spontaneous portosystemic shunts in patients with moderate or severe portopulmonary hypertension (POPH) and determined the association between large shunts and response to treatment. Methods: We performed a retrospective case-control study of data from patients with mild (mean pulmonary artery pressure [MPAP], 25-35 mm Hg; n = 18), moderate (MPAP, 35-50 mm Hg; n = 45), and severe POPH (MPAP, >50 mm Hg; n = 16). Data were compared with those from controls (normal echocardiography with estimated right ventricular systolic pressure, <35 mm Hg; n = 122). Spontaneous portosystemic shunts greater than 10 mm in diameter, identified by computed tomography or magnetic resonance, were classified as large. Response to treatment at 6 months was defined by right ventricular systolic pressure or MPAP as significant (<35 mm Hg), partial (35-50 mm Hg), or no response (>50 mm Hg). Results: The frequency of spontaneous shunts did not differ significantly between groups of subjects with severe (n = 14 of 16), moderate (n = 38 of 45), or mild POPH (n = 11 of 18) or normal echocardiograms (controls, n = 86 of 122) (P = .77). Large shunts were associated with severe (14 of 16) and moderate POPH (32 of 45), compared with mild POPH (6 of 18) or controls (30 of 122) (P < .01). In 13 patients with severe POPH, large shunts were associated with lack of response to treatment in 90% (8 of 9) or partial response in 50% (2 of 4). Among 27 patients with moderate POPH, large shunts were associated with no response to treatment in 13 of 19 (68%) and a partial response in 2 of 6 (33%). Conclusions: Large spontaneous portosystemic shunts are associated significantly with moderate and severe POPH, and with lack of response to treatment.

Original languageEnglish (US)
Pages (from-to)1673-1679
Number of pages7
JournalGastroenterology
Volume141
Issue number5
DOIs
StatePublished - Nov 2011

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Surgical Portasystemic Shunt
Hypertension
Pulmonary Artery
Therapeutics
Pressure
Ventricular Pressure
Echocardiography
Case-Control Studies
Blood Pressure

Keywords

  • Cardiac Output
  • Hemodynamics
  • Portal Hypertension
  • Vasodilators

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Prevalence of spontaneous portosystemic shunts in patients with portopulmonary hypertension and effect on treatment. / Talwalkar, Jayant A.; Swanson, Karen L.; Krowka, Michael Joseph; Andrews, James C.; Kamath, Patrick Sequeira.

In: Gastroenterology, Vol. 141, No. 5, 11.2011, p. 1673-1679.

Research output: Contribution to journalArticle

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abstract = "Background & Aims: We documented the frequency of large spontaneous portosystemic shunts in patients with moderate or severe portopulmonary hypertension (POPH) and determined the association between large shunts and response to treatment. Methods: We performed a retrospective case-control study of data from patients with mild (mean pulmonary artery pressure [MPAP], 25-35 mm Hg; n = 18), moderate (MPAP, 35-50 mm Hg; n = 45), and severe POPH (MPAP, >50 mm Hg; n = 16). Data were compared with those from controls (normal echocardiography with estimated right ventricular systolic pressure, <35 mm Hg; n = 122). Spontaneous portosystemic shunts greater than 10 mm in diameter, identified by computed tomography or magnetic resonance, were classified as large. Response to treatment at 6 months was defined by right ventricular systolic pressure or MPAP as significant (<35 mm Hg), partial (35-50 mm Hg), or no response (>50 mm Hg). Results: The frequency of spontaneous shunts did not differ significantly between groups of subjects with severe (n = 14 of 16), moderate (n = 38 of 45), or mild POPH (n = 11 of 18) or normal echocardiograms (controls, n = 86 of 122) (P = .77). Large shunts were associated with severe (14 of 16) and moderate POPH (32 of 45), compared with mild POPH (6 of 18) or controls (30 of 122) (P < .01). In 13 patients with severe POPH, large shunts were associated with lack of response to treatment in 90{\%} (8 of 9) or partial response in 50{\%} (2 of 4). Among 27 patients with moderate POPH, large shunts were associated with no response to treatment in 13 of 19 (68{\%}) and a partial response in 2 of 6 (33{\%}). Conclusions: Large spontaneous portosystemic shunts are associated significantly with moderate and severe POPH, and with lack of response to treatment.",
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KW - Portal Hypertension

KW - Vasodilators

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