Porto-Pulmonary Venous Anastomosis: A Reversible Cause of Chronic Hypoxemia in Portal Hypertension

  • Anna Berrehare
  • Pascaline PriouEmail author
  • Frédéric Oberti
  • Antoine Bouvier
  • Frédéric Gagnadoux
Letter to the Editor


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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The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Anna Berrehare
    • 1
  • Pascaline Priou
    • 1
    Email author
  • Frédéric Oberti
    • 2
  • Antoine Bouvier
    • 3
  • Frédéric Gagnadoux
    • 1
    • 4
  1. 1.Department of Respiratory DiseaseUniversity Hospital of AngersAngersFrance
  2. 2.Department of Hepatic DiseasesUniversity Hospital of AngersAngersFrance
  3. 3.Department of Interventional RadiologyUniversity Hospital of AngersAngersFrance
  4. 4.INSERM UNIT 1063 “SOPAM”Angers UniversityAngersFrance

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