PREVALENCE OF INTRAPULMONARY VASCULAR DILATATIONS IN NORMOXAEMIC PATIENTS WITH EARLY LIVER-CIRRHOSIS

Background: The aim of this study was to determine the prevalence of i ntrapulmonary vascular dilatations (IPVD) in normoxaemic patients with early liver cirrhosis and to compare their occurrence in progressive alcoholic versus postviral hepatic insufficiency. Methods: Pulmonary f unction tests and arterial blood gas measurements were performed in 75 consecutive patients with cirrhosis of alcoholic and postviral aetiol ogy. Contrast-enhanced echocardiography was used to identify IPVD. Res ults: All patients were grade A or B in accordance with the Child-Pugh modified classification. Arterial blood gas analyses showed normoxaem ia in all patients. Eight of 75 patients (10.7%) had a positive contra st echocardiogram, all with a decreased diffusion capacity (Dl(CO) < 7 5% of the expected value). The abnormality was more prominent with adv ancing stage of liver failure (4.5% in grade A versus 19.4% in grade B ; P < 0.05) and more common in patients with alcoholic cirrhosis (17.5 % in alcoholic versus 2.9% in postviral cirrhosis; P<0.05). Conclusion : In normoxaemic patients with early liver cirrhosis subclinical pulmo nary vasodilatation, as assessed with contrast echocardiography, can o ccur. The finding is more prominent in alcoholic cirrhosis and possibl y reflects an advancing degree of liver insufficiency.