19 Sep

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

Intrapulmonary Vascular Dilatations (IPVD) in Liver Transplant Candidates: ResultsForty 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 set of echocardiograms is shown in Figure 1. A sixth patient (patient 26) had a CE echocardiogram showing immediate appearance of left atrial echoes suggestive of an atrial septal defect or patent foramen ovale with intracardiac right-to-left shunting.
Hypoxemia (Pa02<70 mm Hg) was present in seven (18.4 percent) of 38 patients (Table 1). Of 31 patients without hypoxemia, three (9.7 percent) had positive CE echocardiograms; Pa02 values for these patients were 82, 93, and 97 mm Hg (Table 1). Two (28.6 percent) of seven hypoxemic patients had positive CE echocardiograms; five had negative CE echocardiograms. As shown in Table 2, no significant difference was noted in either arterial blood gas or pulmonary function parameters in those with positive CE echocardiograms compared to those with normal studies.
Further oxygenation data were obtained in patient 37 because of the degree of room air hypoxemia and echo result. Orthodeoxia was demonstrated and a moderate response to 100 percent inspired 02 was noted. Repeated Pa02 supine was 64 mm Hg dropping to 45 mm Hg in the standing position; 100 percent 02 Pa02 was 274 mm Hg supine decreasing to 62 mm Hg standing. You are always offered finest quality purchase alegra at the pharmacy you can fully trust and enjoy being its customer. Why wouldn’t you, if it offers lowest prices in the industry and fast delivery that can be free for some orders?
Five patients had Pa02<70 mm Hg and no evidence of IPVD by echocardiography (Table 1, patients 2, 6, 13, 26, and 36). Patient 26 had a small right-to-left intracardiac shunt at the atrial level. Patient 13 was a smoker with normal PFT results and chest roentgenogram; patients 2 and 6 had mild pulmonary function abnormalities in the form of a restrictive disorder. Patient 36 had normal PFT results and chest roentgenogram. Further pulmonary evaluation was not pursued in these five patients.

Table 1—Individual Liver Transplant Candidate Data (n = 40) 

Clinical History

Arterial Blood Gasest

Smoking

History

Pulmonary Function Tests

Contrast-Enhanced Echo Results

No./Disorder/Age, y/Sex

Po2

Pco2

pH

Hgb Sat

TLC

FVC

FEV1/FVC

MW

Deo

1/PBC/46/M

86.5

37.8

7.41

96

Q

93

91

82

92

62

2/CAH/25/F

67.0

26.4

7.43

91

NS

108

104

87

136

70

N

3/PBC/48/F

85.5

35.2

7.43

95

Q

75

75

85

86

48

N

4/CAH/53/M

94.5

37.1

7.35

96

NS

95

82

91

113

78

TU

5/PBC/50/F

78.5

31.9

7.37

92

NS

93

84

79

83

100

N

6/PBC/40/F

68.0

31.6

7.47

92

NS

74

70

82

86

52

N

7/PSC/57/M

87.5

29.0

7.43

95

NS

78

66

70

62

85

TU

8/ALC/60/M

73.0

35.0

7.48

93

Q

88

70

65

55

77

N

9/PBC/57/F

95.0

35.3

7.42

93

Q

116

116

74

119

86

N

10/CRP/49/F

56.5

39.7

7.46

89

NS

83

70

67

52

42

Positive

11/A1A/45/M

84.0

29.9

7.46

90

S

101

96

84

95

69

N

12/PBC/47/F

77.5

27.3

7.43

95

Q

73

53

99

95

71

N

13/PBC/47/F

68.5

31.5

7.45

94

Q

86

84

92

100

115

N

14/CAH/41/F

108.0

28.7

7.46

94

s

110

110

79

114

92

N

15/CAH/34/M

90.5

28.0

7.44

95

NS

97

94

72

85

100

N

16/PBC/37/F

93.0

30.3

7.42

93

Q

84

83

82

82

75

N

17/CRP/53/F

95.0

34.3

7.42

97

NS

94

105

83

137

80

N

18/POX/33/M

117.5

33.6

7.44

96

Q

83

74

80

81

58

N

19AVIL/26/M

93.5

34.6

7.40

96

NS

103

99

83

89

91

Positive

20/PBC/45/F

79.5

31.7

7.45

95

NS

98

93

76

90

108

N

21/CAH/43/M

89.0

34.1

7.44

95

NS

90

83

79

100

100

N

22/PBC/58/M

89.5

25.7

7.41

95

Q

118

110

76

108

75

N

23/CAH/56/M

76.0

30.6

7.43

95

NS

93

88

76

108

94

N

24/CRP/46/F

77.0

36.3

7.44

93

Q

52

43

87

49

56

N

25/CAH/24/F

97.0

34.6

7.38

96

Q

90

86

87

104

79

Positive

26/CAH/42/M

69.0

26.1

7.47

94

NS

77

74

80

87

74

Positive

27/CAH/36/F

101.0

23.0

7.56

94

Q

84

82

90

128

ND

N

28/PBC/60/M

89.0

34.8

7.42

96

s

101

87

82

76

75

N

29/PBC/53/F

92.5

32.6

7.46

95

NS

71

69

87

114

83

N

30/CAH/40/F

75.5

27.2

7.44

93

Q

77

78

90

100

55

N

31/PBC/44/F

86.0

32.6

7.41

95

Q

88

79

92

79

121

N

32/BCS/35/M

75.5

33.8

7.41

94

Q

54

47

79

54

52

N

33/PBC/52/F

85.0

29.3

7.41

95

Q

100

95

78

107

88

N

34/CRP/67/M

92.0

29.9

7.43

95

Q

63

54

73

32

62

N

35/PSC/42/M

90.5

35.8

7.42

96

NS

91

91

84

90

87

N

36/CAH/40/M

67.5

40.0

7.46

94

NS

113

119

87

125

100

N

37/CAH/37/F

63.5

30.9

7.47

92

Q

102

92

90

115

70

Positive

38/ALC/57/M

82.0

26.2

7.43

95

Q

86

67

73

73

50

Positive

39/PBC/48/F

98.0

28.7

7.47

96

NS

95

96

86

84

99

N

40/PBC/31/F

115.0

23.2

7.37

96

NS

82

82

90

97

93

N

Table 2—Mean Arterial Blood Gas and Pulmonary Function Parameters According to Contrast-Enhanced (CE) Echocardiographic Result

Positive CE

Negative CE

Echocardiogram

Echocardiogram

Mean Parameter

(n = 5)

(n = 32)

Significance

Pa02

78.5 ±17.9

85.9 ±13.0

NS

PaC02

33.2±5.0

31.3±4.1

NS

pH

7.43 ±.04

7.44± .03

NS

TLC

93±9

89 ± 16

NS

(% predicted)

FVC

83± 14

84± 17

NS

(% predicted)

FEV/FVC (%)

80± 10

82 ±7

NS

Deo (% predicted)

66 ±20

81 ±19

NS

MW

87 ±25

93±24

NS

(% predicted)

Figure_1
Figure 1. Contrast-enhanced echocardiograms showing evidence for intrapulmonary vascular dilatations (IPVD) in patient 37 with cryptogenic cirrhosis and room air/sitting Pa02 = 63 mm Hg. A (top). Normal four-chamber view; B (center). Microbubble opacification of right heart; C (bottom). Delayed (3 to 5 beats) microbubble opacification of left heart.

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