Pulmonary hypertension after transjugular intrahepatic porto systemic shunt: Effects on right ventricular function

Abstract

The short- and mid-term hemodynamic effects of transjugular intrahepatic portosystemic shunt (TIPS) were studied in 16 sedated cirrhotic patients. Indications included relapsing variceal bleeding (n = 10) and refractory ascites (n = 6). The decrease of porto-atrial pressure gradient (from 20.4 ±4.2 mm Hg to 10.1 ± 2.4 mm Hg; P < .05) was associated with an increase of mean pulmonary artery pressure (MPAP) (from 12.3 ± 3.0 mm Hg to 20.3 ± 5.3 mm Hg; P < .05) and of right atrial pressure (RAP) (from 3.4 ± 2.6 mm Hg to 8.3 ± 3.7 mm Hg; P < .05). After transient shunt occlusion with a balloon catheter, all of the hemodynamic parameters returned to baseline values, except pulmonary artery pressure, which also decreased but remained significantly increased. One month after TIPS, pulmonary pressure remained elevated, and CI further increased. It is concluded that increased PVR is the major hemodynamic alteration occurring after TIPS placement. It correlates with the decrease of porto-atrial gradient and is probably mediated by both mechanical and neurohumoral factors. Copyright © 1996 by the American Association for the Study of Liver Diseases.