Transition from Hepatopulmonary Syndrome to Portopulmonary Hypertension: A Case Series of 3 Patients
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TLDR
Three patients with severe hepatopulmonary syndrome who had spontaneous resolution of their HPS with the subsequent development of PPHTN are presented, which is the largest case series presented of this phenomenon in nontransplanted patients.Abstract:
Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) are the two major pulmonary vascular complications of liver disease. While HPS is characterized by low pulmonary vascular resistance, PPHTN is defined by the presence of elevated pulmonary vascular resistance. Given these seemingly opposing pathophysiologic mechanisms, these conditions were traditionally felt to be mutually exclusive. In this series, we present three patients with severe hepatopulmonary syndrome who had spontaneous resolution of their HPS with the subsequent development of PPHTN. To our knowledge, this is the largest case series presented of this phenomenon in nontransplanted patients. One proposed mechanism for the occurrence of this phenomenon involves dysregulation of the same vascular signaling pathway, which may lead to both pulmonary vascular dilatations and pulmonary arterial remodeling in the same patient. Another theory involves the possible differential binding of endothelin-1, a vasoactive signaling peptide that induces vasoconstriction when bound to receptor A and vasodilation when bound to receptor B. Although the mechanisms for this phenomenon remain unclear, it is important to be vigilant of this phenomenon as it may change the patient's overall treatment plan, especially in regard to appropriateness and timing of liver transplant.read more
Citations
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Journal ArticleDOI
2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: In this paper, the authors defined the following terms: ALAT, alanine aminotransferase, ASAT, aspartate AMINOTE, and APAH, associated pulmonary arterial hypertension.
Journal ArticleDOI
Special article2015 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew J. Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Marius M. Hoeper +18 more
TL;DR: This article is being published concurrently in the European Heart Journal and the European Respiratory Journal and is identical except for minor stylistic and spelling differences in keeping with each journal’s style.
Journal ArticleDOI
[2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension].
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew J. Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) is constituted.
Journal ArticleDOI
2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper +20 more
TL;DR: In this article, guidelines summarize and evaluate all available evidence on a particular issue, with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome, as well as the risk-benefit ratio of particular diagnostic or therapeutic means.
Journal ArticleDOI
Guía ESC/ERS 2015 sobre diagnóstico y tratamiento de la hipertensión pulmonar
Nazzareno Galiè,Marc Humbert,Jean-Luc Vachiery,Simon Gibbs,Irene Lang,Adam Torbicki,Gérald Simonneau,Andrew J. Peacock,Anton Vonk Noordegraaf,Maurice Beghetti,Ardeschir Ghofrani,Miguel Angel Gomez Sanchez,Georg Hansmann,Walter Klepetko,Patrizio Lancellotti,Marco Matucci,Theresa McDonagh,Luc Pierard,Pedro T. Trindade,Maurizio Zompatori,Marius M. Hoeper,Victor Aboyans,Antonio Vaz Carneiro,Stephan Achenbach,Stefan Agewall,Y. Allanore,Riccardo Asteggiano,Luigi Paolo Badano,Joan Albert Barberà,Hélène Bouvaist,Héctor Bueno,Robert A. Byrne,Scipione Carerj,Graça Castro,Çetin Erol,Volkmar Falk,Christian Funck-Brentano,Matthias Gorenflo,John Grantonc,Bernard Iung,David G. Kiely,Paulus Kirchhof,Barbro Kjellstrom,Ulf Landmesser,John Lekakis,Christos Lionis,Gregory Y.H. Lip,Stylianos E. Orfanos,Myung H. Park,Massimo F. Piepoli,Piotr Ponikowski,Marie Pierre Revel,David Rigau,Stephan Rosenkranz,Heinz Völler,José Luis Zamorano +55 more
TL;DR: Aprobada por the Association for European Paediatric and Congenital Cardiology (AEPC) y the International Society for Heart and Lung Transplantation (ISHLT)
References
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Journal ArticleDOI
Portopulmonary hypertension and hepatopulmonary syndrome
TL;DR: Criteria that allow improved prediction of which patients may, or may not, benefit from liver transplantation alone are provided, which are particularly challenging in patients who have severe pulmonary disease involvement.
Journal ArticleDOI
Genetic basis of pulmonary arterial hypertension: current understanding and future directions.
John H. Newman,Richard C. Trembath,Jane A. Morse,Ekkehard Grünig,James E. Loyd,Serge Adnot,Fabio Coccolo,Carlo Ventura,John A. Phillips,James A. Knowles,Bart Janssen,Oliver Eickelberg,Saadia Eddahibi,Phillipe Herve,William C. Nichols,Gregory Elliott +15 more
TL;DR: To elucidate the genetic basis of PAH further, investigations are needed, including genome scanning for major and minor genes, analysis of genetic profiles of patients for candidate genes likely to modify risk for disease, proteomics, transgenic mice, and altered signal transduction.
Journal ArticleDOI
Hepatopulmonary syndrome with progressive hypoxemia as an indication for liver transplantation: case reports and literature review.
Michael J. Krowka,Michael K. Porayko,David J. Plevak,S. Chris Pappas,Jeffrey L. Steers,Ruud A.F. Krom,Russell H. Wiesner +6 more
TL;DR: In these patients, the progressive pulmonary deterioration accelerated the need and was considered an indication for liver transplantation rather than being considered an absolute or relative contraindication.
Journal ArticleDOI
The role of endothelin-1 in the pathogenesis of pulmonary arterial hypertension
TL;DR: Plasma ET-1 levels are raised in patients with PAH and correlate with important clinical outcomes, and ET- 1 receptor antagonism has been demonstrated to improve both morbidity and mortality in conditions associated withPAH.