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 analyses while breathing 100 percent inspired 02 under controlled conditions (patient position, nose-clips, tight mouth seal), oxygenation capability can be obtained as practical data for the liver transplant anesthesiologist and surgeon. Are these data clinically important? Perhaps hypoxemia associated as intracardiac right-to-left shunting complicating pulmonary hypertension portends greater transplant risk than hypoxemia secondary to massive ascites and pleural effusions. Indeed, some intrapulmonary right-to-left shunts with hypoxemia have apparently failed to close following otherwise successful liver transplantation and directly resulted in prolonged mechanical ventilation and death. Centers now consider severe hypoxemia due to intrapulmonary right-to-left shunting a “relative” contraindication to transplantation. What is the “relative” cut off and what data support that contention? You can finally enjoy safe online shopping for generic viagra canada with the pharmacy you can fully trust no matter if you need a small amount of this medicine or would like to purchase it in bulk not to have to think about it for a long time.

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