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==Overview==
==Overview==
==Echocardiography==
==Echocardiography==
The diagnosis of portopulmonary hypertension is based on [[hemodynamic]] criteria:
The diagnosis of portopulmonary hypertension is based on hemodynamic criteria:


#. [[Portal hypertension]] and/or liver disease (clinical diagnosis-[[ascites]]/[[varices]]/[[splenomegaly]])
#. Portal hypertension and/or liver disease (clinical diagnosis—ascites/varices/splenomegaly)
#. Mean [[pulmonary artery pressure]]-MPAP > 25 mmHg at rest
#. Mean pulmonary artery pressure—MPAP > 25 mmHg at rest
#. [[Pulmonary vascular resistance]]-PVR > 240 dynes s cm-5
#. Pulmonary vascular resistance—PVR > 240 dynes s cm−5
#. Pulmonary artery occlusion pressure (PAOP) < 15mmHg or transpulmonary gradient (TPG) > 12 mmHg where TPG = MPAP − PAOP.
#. Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP.<ref name=swanson>Swanson KL et al. Survival in Portopulmonary Hypertension: Mayo Clinic Experience Categorized by Treatment Subgroups. Am J Transpl 2008; 8: 2445–2453</ref>
 
The diagnosis is usually first suggested by a [[transthoracic]] [[echocardiogram]], part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis, with a sensitivity of 100% and a [[specificity]] as high as 96%.<ref name=Kim> The negative predictive value of this method is 100% but the [[positive predictive value]] is 60%.


The diagnosis is usually first suggested by a transthoracic [[echocardiogram]], part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis,<ref>Torregosa et al. Role of Doppler echos in the assessment of PPHTN in liver transplant candidates. Transplantation 2001;71:572-574</ref> with a sensitivity of 100% and a specificity as high as 96%. The negative predictive value of this method is 100% but the positive predictive value is 60%.<ref name=Colle> Colle et al. Diagnosis of portopulmonary hypertension in candidates for liver transplant: a prospective study. Hepatology 2003;37:401-209</ref>
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 18:04, 24 September 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Echocardiography

The diagnosis of portopulmonary hypertension is based on hemodynamic criteria:

  1. . Portal hypertension and/or liver disease (clinical diagnosis—ascites/varices/splenomegaly)
  2. . Mean pulmonary artery pressure—MPAP > 25 mmHg at rest
  3. . Pulmonary vascular resistance—PVR > 240 dynes s cm−5
  4. . Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP.[1]

The diagnosis is usually first suggested by a transthoracic echocardiogram, part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis,[2] with a sensitivity of 100% and a specificity as high as 96%. The negative predictive value of this method is 100% but the positive predictive value is 60%.[3]

References

  1. Swanson KL et al. Survival in Portopulmonary Hypertension: Mayo Clinic Experience Categorized by Treatment Subgroups. Am J Transpl 2008; 8: 2445–2453
  2. Torregosa et al. Role of Doppler echos in the assessment of PPHTN in liver transplant candidates. Transplantation 2001;71:572-574
  3. Colle et al. Diagnosis of portopulmonary hypertension in candidates for liver transplant: a prospective study. Hepatology 2003;37:401-209

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