in 2006 patient operated due to gastroesophageal bleeding. Operation- end to side iliaco mesenterial anastomosis (v. iliaca communis dextra to v/ mesenterica superior). Year after postoperative period patient began to complain on cyanosis, and clubbing of fingers. SpO2 - 66%. Echocardiography-clear. On angiopulmonography also no evidence of arteriovenous fistula in lungs!
What was the value of pulmonary pressure?
If high could be porto-pulmonary hypertension
Did you performed a contrast enhancement echocardiography with microbubbles?
What is the value of alpha-1-antitrypsin?
Very high chances of hepatopulmonary syndrome. contrasst echo or a Tc -albumin scan to identify
The value of pulmonary artery pressure 20-23/13 mmHg., VCS and right atrium 5/2 mmHg, right vintricle pressure was 25/3 mmHg. We didn't perform contrast esho scan, and didn't measure value of alpha-1-antitrypsin! Is it really necessery to perform contrast esho scan if we didn't find a/v fistula during angiopulmonography
The contrast enhancement echocardiography is essential for the diagnosis of hepato-pulmonary syndrome
The increase of NO determines the opening of arteriovenous shunts in the pulmonary vascular bed that are responsible for the onset of hepatopulmonary syndrome