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Heart, Lung and Circulation

Portopulmonary Hypertension: A Review of the Current Literature

      Portopulmonary hypertension is defined as the development of pulmonary arterial hypertension in the setting of portal hypertension with or without liver cirrhosis. Portal hypertension-associated haemodynamic changes, including hyperdynamic state, portosystemic shunts and splanchnic vasodilation, induce significant alterations in pulmonary vascular bed and play a pivotal role in the pathogenesis of the disease. If left untreated, portopulmonary hypertension results in progressive right heart failure, with a poor prognosis. Although Doppler echocardiography is the best initial screening tool for symptomatic patients and liver transplantation candidates, right heart catheterisation remains the gold standard for the diagnosis of the disease. Severe portopulmonary hypertension exerts a prohibitive risk to liver transplantation by conferring an elevated perioperative mortality risk. It is important for haemodynamic parameters to correspond with non-severe portopulmonary hypertension before patients can proceed with the liver transplantation. Small uncontrolled studies and a recent randomised controlled trial have reported promising results with vasodilatory therapies in clinical and haemodynamic improvement of patients, allowing a proportion of patients to undergo liver transplantation. In this review, the epidemiology, pathogenesis, diagnostic approach and management of portopulmonary hypertension are discussed. We also highlight fields of ongoing investigation pertinent to risk stratification and optimal patient selection to maximise long-term benefit from currently available treatments.

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      Linked Article

      • Portopulmonary Hypertension: The Interplay Between the Liver and Pulmonary Arteries
        Heart, Lung and CirculationVol. 31Issue 9
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          Portopulmonary hypertension (PPHTN) is a cause of pre-capillary pulmonary hypertension (PH) that occurs in the setting of advanced liver disease [1]. It highlights the close and dynamic relationship between the liver, right ventricle (RV), and pulmonary arteries (Figure 1). However, it is not as simple as the pressure transmission across a compliant, low-pressure right ventricle and associated remodelling. Peppas et al. [2] provide a comprehensive review of PPHTN, but also show that there are still significant gaps in our knowledge and clinical practice with regards to this type of PH.
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