Porto-Pulmonary Venous Anastomosis: A Reversible Cause of Chronic Hypoxemia in Portal Hypertension
Letter to the Editor
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The two main mechanisms of hypoxemia in portal hypertension (PH) are hepatopulmonary syndrome and porto-pulmonary hypertension which occur respectively in 15% and 2–5% of cirrhotic patients [ 1]. We describe a case of PH-related hypoxemia due to a porto-pulmonary venous anastomosis (PPVA), and its improvement after embolization. A 70-year-old woman with no underlying cardiovascular or pulmonary illnesses was admitted for Child Pugh B7 cirrhosis revealed by esophageal varices rupture. The patient had severe dyspnea with a modified Medical Research Council (mMRC) score of 3/4. Arterial blood gas (ABG) showed PaO 2: 65 mmHg, PaCO 2: 33 mmHg, pH: 7.49. Seven days after esophageal varices ligation, ABG showed a decrease in PaO 2 from 65 to 54 mmHg with an alveolo-arterial oxygen gradient of 54 mmHg. Pulse oximetry revealed orthodeoxia with a drop in SpO 2from 92% while supine to 83% while upright. On pulmonary function tests, carbon monoxide diffusion capacity was 67% of predicted value...
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- 4.Masi L, André A, Rémy-Jardin M, Rémy J. Anastomose porto-pulmonaire veineuse et hypertension portale. J Radiol. 2008;83(11):1769–71.Google Scholar
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