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Pulmonary hypertension after transjugular intrahepatic portosystemic shunt: Effects on right ventricular function
Author(s) -
Van der Linden P,
Le Moine O,
Ghysels M,
Ortinez M,
Deviere J
Publication year - 1996
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510230507
Subject(s) - medicine , vascular resistance , cardiology , hemodynamics , pulmonary artery , transjugular intrahepatic portosystemic shunt , pulmonary wedge pressure , cardiac index , pulmonary hypertension , inferior vena cava , central venous pressure , portal hypertension , blood pressure , ventricular pressure , cardiac output , heart rate , cirrhosis
The short‐ and mid‐term hemodynamic effects of transjugular intrahepatic portosystemic shunt (TIPS) were studied in 16 sedated cirrhotic patients. Indications included relapsing variceal bleeding (n = 10) and refractory ascites (n = 6). The decrease of porto‐atrial pressure gradient (from 20.4 ± 4.2 mm Hg to 10.1 ± 2.4 mmHg; P < .05) was associated with an increase of mean pulmonary artery pressure (MPAP) (from 12.3 ± 3.0 mm Hg to 20.3 ± 5.3 mm Hg; P < .05) and of right atrial pressure (RAP) from 3.4 ± 2.6 mm Hg to 8.3 ± 3.7 mm Hg; P < .05), whereas right ventricular end‐diastolic volume (RVEDVI) remained unchanged. The significant increase of cardiac index (CI) (from 4.5 ± 1.2 L/min/m 2 to 5.0 ± 1.1 L/min/m 2 ; P < .05) was essentially attributable to an increase of heart rate (HR) (from 81 ± 11 to 88 ± 10 beats/min; P < .05). Systemic vascular resistance (SVR) decreased (from 812 ± 281 to 666 ± 191 dynes/sec/cm 5 ; P < .05), whereas pulmonary vascular resistance (PVR) increased (from 60.6 ± 29.6 to 82.0 ± 34.6 dynes/sec/cm5; P < .05). After transient shunt occlusion with a balloon catheter, all of the hemodynamic parameters returned to baseline values, except pulmonary artery pressure, which also decreased but remained significantly increased. One month after TIPS, pulmonary pressure remained elevated, and CI further increased. It is concluded that increased PVR is the major hemodynamic alteration occurring after TIPS placement. It correlates with the decrease of porto‐atrial gradient and is probably mediated by both mechanical and neurohumoral factors.