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World J Gastroenterol. Nov 21, 2005; 11(43): 6858-6862 Published online Nov 21, 2005. doi: 10.3748/wjg.v11.i43.6858
Effect of transjugular intrahepatic portosystemic shunt on pulmonary gas exchange in patients with portal hypertension and hepatopulmonary syndrome
Graciela Martínez-Pallí, Britt B Drake, Joan-Carles García-Pagán, Joan-Albert Barberà, Miguel R Arguedas, Robert Rodriguez-Roisin, Jaume Bosch, Michael B Fallon
Graciela Martínez-Pallí, Servei d’Anestesiologia i Reanimació. Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
Britt B Drake, Miguel R Arguedas, Michael B Fallon, University of Alabama at Birmingham Liver Center, 290 MCLM, 1918 University Blvd., Birmingham, AL 35294-0005, United States
Joan-Carles García-Pagán, Jaume Bosch, Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Robert Rodriguez-Roisin, Joan-Albert Barberà, Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clinic de Pneumologia I Cirurgia Toràcica , Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Author contributions: All authors contributed equally to the work.
Supported by FIS 02/0692 and 02/0739 from the Fondo de Investigaciones Sanitarias, SGR 2001 SGR00286 from the Generalitat de Catalunya (DURSI), and CO 3/02 and CO 3/11 from the Instituto de Salud Carlos III
Received: February 4, 2005 Revised: May 8, 2005 Accepted: May 12, 2005 Published online: November 21, 2005
Abstract
AIM: To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on pulmonary gas exchange and to evaluate the use of TIPS for the treatment of hepatopulmonary syndrome ( HPS ).
METHODS: Seven patients, three of them with advanced HPS, in whom detailed pulmonary function tests were performed before and after TIPS placement at the University of Alabama Hospital and at the Hospital Clinic, Barcelona, were considered.
RESULTS: TIPS patency was confirmed by hemodynamic evaluation. No changes in arterial blood gases were observed in the overall subset of patients. Transient arterial oxygenation improvement was observed in only one HPS patient, early after TIPS, but this was not sustained 4 mo later.
CONCLUSION: TIPS neither improved nor worsened pulmonary gas exchange in patients with portal hypertension. This data does not support the use of TIPS as a specific treatment for HPS. However, it does reinforce the view that TIPS can be safely performed for the treatment of other complications of portal hypertension in patients with HPS.
