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1 From the Department of Surgery, University of Maryland Medical System, Baltimore
2 From the Department of Anesthesia, University of Maryland Medical System, Baltimore
3 From the Department of Medicine, University of Maryland Medical System, Baltimore
Study objective: To differentiate the cardiopulmonary profile of portopulmonary hypertension (PPHTN) from that of primary pulmonary hypertension and chronic liver disease.
Design: Retrospective survey.
Setting: Tertiary care center.
Patients: Thirty patients with cardiac catheterization-proven PPHTN were compared to 30 randomly selected patients with primary pulmonary hypertension alone and 30 patients with chronic liver disease alone necessitating consideration of liver transplantation (L-CONT).
Interventions: All patients underwent right heart catheterization, echocardiography, ECG, chest radiography, pulmonary function tests, ventilation-perfusion scanning, and room air arterial blood gas measurements.
Results: Patients with PPHTN exhibited elevated pulmonary pressures (mean pulmonary pressure, 48.6±2.1 mm Hg) and pulmonary vascular resistance (11.6±1.6 mm Hg/L/min/m2) with simultaneous elevation in the cardiac index (3.8±0.3 L/min/m2) and depression of systemic vascular resistance (24.9±1.7 mm Hg/L/min/m2). Arterial blood gas measurements indicate that PPHTN exhibits a significant accentuation of the chronic respiratory alkalosis (Pco2, 28.7±0.5 mm Hg) usually seen with chronic liver disease and pulmonary hypertension. In addition, patients with PPHTN have an increased alveolar-arterial gradient (27.0±2.7 mm Hg) when compared to patients with L-CONT, suggesting impaired gas exchange.
Conclusions: PPHTN is associated with a unique clinical profile that possesses characteristics common to and exclusive of liver disease and primary pulmonary hypertension.
Key Words: alkalosis • cirrhosis • gas exchange • liver • liver transplantation • pulmonary hypertension
Submitted on December 27, 1996
Accepted on April 15, 1997
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