LIVER Portopulmonary hypertension in decompensated cirrhosis with refractory ascites

Background: The prevalence of portopulmonary hypertension (PPHTN) in patients with cirrhosis and refractory ascites is unknown. Its presence may preclude patients from receiving a transjugular intra-hepatic portosystemic shunt or liver transplantation as a definitive treatment for their end stage cirrho-sis. Purpose: To determine the prevalence, possible aetiological factors, and predictive factors for the development of PPHTN in these patients. Methods: Sixty two patients (53 males, nine females; mean age 54.5 (1.4) years) with biopsy proven cirrhosis and refractory ascites underwent angiographic measurements of pulmonary and splanchnic haemodynamics. Endothelin 1 levels were measured from the pulmonary artery. Forty nine patients underwent radionuclide angiography for measurements of central blood volume, pulmonary vascular, and cardiac chamber volumes. Forty seven patients also underwent two dimensional echocardio-graphy for measurements of cardiac structural and functional parameters. Cardiac output, and systemic and pulmonary vascular resistance were calculated. Results: Ten patients (16.1%) fulfilled the criteria for PPHTN (mean pulmonary artery pressure>25 mm Hg and pulmonary vascular resistance>120 dyn×s/cm5), with significantly higher mean right atria