Archive for the 'Intrapulmonary Vascular Dilatations' Category

25 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 6)

Recent data suggest that some intrapulmonary shunting associated with significant hypoxemia does resolve following successful transplantation. Patient 37 in our study showed no change in the severe pretransplant hypoxemia when restudied with CE echocardiography and blood gas studies 25 days after uncomplicated transplantation.

24 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 5)

From a practice perspective, this technique is most useful in the noninvasive evaluation of severe hypoxemia in liver transplant candidates. A positive CE echocardiogram suggests the existence of a right-to-left shunt as a factor in hypoxemia. Moreover, this method localizes the shunting process to either the heart or lungs. In conjunction with arterial blood gas […]

23 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 4)

During inspiration, these vessels were found to dilate significantly. Corner vessels were thought to function as a potential arteriovenous anastomosis in that venous blood could flow through these channels during wide swings in alveolar pressure. Either of these situations, if present in humans, could be the source of microbubble passage through normal lung tissue in […]

22 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 3)

Our findings of positive CE echocardiography in patients without hypoxemia are consistent with the data reported by Berthelot et al and more recent animal studies. In the Berthelot et al study, 13 patients with cirrhosis were studied post mortem with pulmonary vascular microopaque injections. Each patient has some degree of pulmonary/pleural vasodilation and seven patients […]

21 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 2)

Extrapulmonary radionuclide scanning with “TcMAA has suggested the existence of right-to-left intrapulmonary shunting in that the albumin particles are 20 to 60 |xm in diameter and more than 95 percent of the particles are trapped in capillary beds that are approximately 8 to 15 jim in diameter. This technique, by itself, does not distinguish between […]

20 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Discussion (Part 1)

This study found a 13.2 percent prevalence of positive CE echocardiography in patients with advanced liver disease, suggesting the existence of IPVD. Positive CE echocardiography was not necessarily associated with hypoxemia, indicating a spectrum of vascular dilatations ranging from subclinical presence to severe hypoxemia in the standing position. These findings raise questions concerning the gold […]

19 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Results

Forty consecutive liver transplant candidates were studied and 38 (95 percent) had technically satisfactory CE echocardiograms. The two unsatisfactory examinations were on patients with massive ascites and clinical problems that precluded an acceptable study (Table 1, patients 4 and 7). Positive CE echocardiograms occurred in five (13.2 percent) of 38 patients (Table 1). A representative […]

18 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: Methods

Our protocol was approved by the Institutional Review Board and patient consent was obtained from 40 consecutive liver transplant candidates. As part of routine pretransplant pulmonary (unction assessment, arterial blood gases were obtained on each patient while they were seated, at rest, and breathing room air (IL 1304 pH analyzer and IL 284 CO-oximeter). Each of […]

17 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates (Part 2)

The microbubbles are subsequently trapped and absorbed during the first pass through the normal pulmonary circulation and do not enter the left atrium via pulmonary veins. Echocardiography of the left heart chambers, therefore, shows no opacification. In the presence of a right-to-left shunt at the atrial or ventricular level, there is immediate left heart opacification […]

16 Sep

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates (Part 1)

Intrapulmonary vascular dilatations (IPVD) are considered to be extrahepatic complications of acute and chronic liver disorders. Pathologically, IPVD have been defined by postmortem micro-opaque gelatin suspension injections into the pulmonary arterial bed that have shown dilated precapillaries, direct arteriovenous communications, and dilated pleural vessels resembling cutaneous “spider nevi.” Anatomically, venous blood may preferentially flow through […]

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