Pulmonary arterial hypertension in disorders of porto-caval hemodynamics. The role of ultrasound diagnostics

Portal hypertension is a complex syndrome that effects the systemic circulation. Some authors name pulmonary hypertension with portal hypertension such as portopulmonary hypertension. According to foreign registries, the prognosis of patients with portopulmonary hypertension is one of the most unfavorable. Ultrasound diagnostic methods are ones of keis to confirm portopulmonary hypertension, while echocardiography detects high pressure in the pulmonary artery, liver ultrasound with vascular doppler reveals changes in portocaval blood flow. Aim. To analyze the clinical, functional and hemodynamic status of patients with pulmonary arterial hypertension with portocaval hemodynamic disorders. To demonstrate the significance of abdominal ultrasonic diagnostics in determining the genesis of pulmonary hypertension. Material and methods. The study enrolls 14 patients with portocaval disorders. There were 5 patients with cirrhotic portal hypertension, 6 patients with Abernethy malformation and 3 patients with surgical portocaval shunts among them. All patients had a complex examination that included laboratory tests, echocardiography, abdominal ultrasound with Doppler ultrasonography and the right heart catheterization. Results. Among 14 patients, portocaval hemodynamic abnormalities were detected more often in women (73.3%). The mean age was 53.2±10.9 years. We knew about 5 patients (10%) with diagnosis of liver cirrhosis, three patients (5%) had got surgical portocaval shunts, 6 (10%) patients had Abernethy malformation. According to echocardiography, right atrial area was 25.3±2.3 cm2, pulmonary artery systolic pressure was 96±10.8 mm Hg. According to right heart catheterization data the median mean pulmonary arterial pressure was 59±10 mm Hg, SpO2 95.7±2.22%, cardiac output 4.6±0.9 L/min, the median pulmonary vascular resistance was 943.5±87.3 din sec/cm-5. The median 6-minute walking distance was 429.5±70.4 meters, which was corresponding to WHO functional class II, the median Borg dyspnea index was 4±1.7. Conclusions. All patients with pulmonary hypertension are shown to exclude portocaval shunts. The study of clinical features, functional and hemodynamic status of these patients will help to find the optimal treatment and tactical solutions.