Left ventricular dilation and pulmonary vasodilatation after surgical shunt for treatment of pre-sinusoidal portal hypertension

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Abstract

© 2016 Santarém et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Objective: The aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni. Location: The University of São Paulo Medical School, Brazil; Public Practice. Methods: Hemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1 - distal splenorenal shunt (DSRS, n = 13) and group 2 - esophagogastric devascularization and splenectomy (EGDS, n = 15). Results: The cardiac output (5.08 ± 0.91 L/min) and systolic volume (60.1 ± 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05). Conclusions: The late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.

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Santarém, O. L. D. A., De Cleva, R., Sasaya, F. M., De Assumpção, M. S., Furtado, M. S., Barbato, A. J. G., & Herman, P. (2016). Left ventricular dilation and pulmonary vasodilatation after surgical shunt for treatment of pre-sinusoidal portal hypertension. PLoS ONE, 11(4). https://doi.org/10.1371/journal.pone.0154011

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