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 (54 percent) had Pa02 greater than 70 mm Hg measured before death. Three patients had Pa02 greater than 90 mm Hg. Patient position in which blood gas determinations were obtained was not described, nor were controls studied. Some vasodilatations that are detected by positive CE echocardiography in patients with normal Pa02 may only reflect vasodilatation on the pleural surfaces, which embraces a very small degree of total cardiac output. Vasodilatation of precapillaries or direct arteriovenous communications most likely account for the severe oxygenation problems. Shop with pleasure with most reliable pharmacy you have ever seen, paying less for your Generic Claritin always being sure you are being treated with all due respect, being an important customer whose interests are respected and taken into account.
Animal studies in the setting of normal liver function suggest the existence of a two- to three-fold dilatation of capillaries in isolated, perfused dog lungs studied by rapid frozen analysis. In addition, Fishman has reviewed unconventional components of the lung microcirculation in animals and described both extra-alveolar and corner vessels that abut normal alveolar structures.