Hepatopulmonary Syndrome: Could Contrast Transesophageal Echocardiography be the Gold Standard for Diagnosis?

Walnei Fernandes Barbosa^1*, Fatima Pereira de Souza², Evelyn Pedroso Toscano Quintino² & Giovanni Faria Silva¹

¹Paulista State University, Departments of Clinical Medicine, Gastroenterology, São Paulo, Brazil
²Paulista State University, Departments of Physics and Multiuser Center Innovation Biomolecular, Molecular Biology, São Paulo, Brazil

Dr. Walnei Fernandes Barbosa, Paulista State University, Departments of Clinical Medicine, Gastroenterology, São Paulo, Brazil.

Keywords: Hepatopulmonary Syndrome; Transthoracic Echocardiography; Transesophageal Echocardiography; Cirrhosis; Hypoxemia

Abstract

Hepatopulmonary syndrome (HPS) is a clinical relationship between liver disease and intrapulmonary vasodilatations that may result in hypoxemia. HPS may be diagnosed using transthoracic echocardiography (TTE), currently considered the gold standard, or transesophageal echocardiography (TEE) having been described to present greater sensitivity for the detection of bubbles (contrast). The aim of this study was to determine the prevalence of HPS and evaluate the role of contrast TEE in defining diagnosis in the service and to evaluate the role of the TEE in the diagnosis definition. The study admitted patients with liver cirrhosis with different ethology and no primary pulmonary or cardiac disease and a control group of 20 individuals without pulmonary or primary cardiac disease, whose indication of TEE was for stroke in young people to evaluate the presence of patent foramen ovale. Patients and controls were submitted to contrast TTE and TEE, spirometry, chest x-ray and arterial blood gas analysis. Of 59 patients included, 47 (79.7%) were male. Mean age was 48 ± 11 years. Fifteen patients (25.4%) were classified as Child-Pugh A, 30 (50.8%) as B and 14 (23.7%) as C.

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