Detection of intrapulmonary vascular dilatations [IPVD] in patients with chronic liver disease by contrast-enhanced echocardiography using indocyanine green dye VS. isotonic saline

ABSTRACT

Intrapulmonary vascular dilatations [IPVD] are extrahepatic complications of acute and chronic liver disorders that can result in severe hypoxemia. Contrast-enhanced [CE] echocardiography provides a noninvasive method to detect right-to- left shunting associated with IPVD. We studied 23 patients with chronic liver disease to determine the prevalence of positive CE echocardiography suggesting the presence of IPVD and its relationship to arterial blood gases. None of our patients had schistosomal cor pulmonale. Five [21.7 percent] of.23 patients were hypoxemic [PaO 2<70mm Hg]. Eighteen patients [79.3 percent] had PaO 2>70mm Hg. Positive CE echocardiograms suggesting IPVD were found in 6 [26.08 percent] of 23. Three [16.7 percent] of the 18 patients with PaO 2>7Omm Hg had positive CE echocardiograms. Three [60 percent] of the five hypoxemic patients had positive CE echocardiograms. Patients with positive CE echocardiograms using indocyanine green [ICG] dye solution as a contrast were the same patients who had positive CE echocardiograms using isotonic saline solution alone as a contrast. No significant difference in the mean value of PaO 2 was noted between patients with positive and negative CE echocardiograms. We conclude that for our group of patients with chronic liver diseases, [1] IPVD as suggested by CE echo-cardiography were common [26.08 percent], [2] positive CE echocardiography could be documented in patients who were not hypoxemic [16.7 percent], [3] isotonic saline solution alone can be used as a reliable and cheap alternative for ICG dye solution in CE echocardiographic studies, [4] the presence of positive correlation between IPVD and spider naevi and esophageal varices, and [5] the absence of correlation between the Child's classification of liver dysfunction and the presence of IPVD