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 these dilated vascular channels (diameters ranging from 15 to 500 jxm), bypassing normal-sized capillaries (diameters approximately 8 to 15 |xm) and gas exchange units. Physiologically, the clinical manifestations of such vascular dilatations can include severe hypoxemia (Pa02<50 mm Hg) associated with orthodeoxia and platypnea. In addition, Pa02<50 mm Hg due to such intrapulmonary right-to-left shunting is currently considered to be a relative contraindication to liver transplantation.
Contrast-enhanced (CE) two-dimensional echocardiography is a noninvasive technique that not only detects but can also distinguish between intrapulmonary and intracardiac right-to-left shunting. In normal individuals, proper injection of a contrast agent such as indocyanine green dye provides a stream of microbubbles (diameters up to 90 |xm) that result only in the opacification of the right heart chambers by transthoracic or transesophageal echocardiography. Looking for a great online pharmacy you could trust and where you could find Buy Claritin online at best prices? You have one pharmacy like that already and can finally enjoy the best quality of service ever experienced.