Systemic hemodynamic changes in mansonic schistosomiasis with portal hypertension treated by azygoportal disconnection and splenectomy

OBJECTIVE: The aim of this study was to assess systemic hemodynamic changes in patients with Manson's schistosomiasis and portal hypertension during a zygoportal disconnection and splenectomy. METHODS: Sixteen patients with portal hypertension secondary to hepatosplen ic schistosomiasis with indication for surgery were studied prospectively. All underwent invasive hemodynamic monitoring with pulmonary artery cathete r. The first systemic hemodynamic assessment was performed preoperatively. In the intraoperative period new hemodynamic data were collected as follows : a) after laparotomy: b) 15-30 min after splenic artery ligature; c) 15-30 min after splenectomy; and d) after ligation of the collateral circulation . RESULTS: The results indicated preoperatively that the patients presented w ith an increased cardiac index (4.40 +/- 0.94 L/min/m(2)) together with a r eduction in the systemic vascular resistance index (1692.25 +/- 434.91 dyne .s/ cm(5).m(2)). The stroke index (53.74 +/- 10.40 ml/beat/m(2)) and both l eft (5.71 +/- 1.50 kg.m/m(2)) and right heart work indexes (1.12 +/- 0.74 k g.m/m(2)) were also elevated. The mean pulmonary artery pressure was increa sed (17.81 +/- 9.00 mm Hg) and the pulmonary vascular resistance index decr eased (164.31 +/- 138.69 dyne.s/cm(5).m(2)). From the moment that the splen ic artery was Ligated until the end of the procedure, the cardiac index (3. 45 +/- 0.90 L/min/m(2)) was reduced and the systemic vascular resistance in dex (2059.50 +/- 590.05 dyne.s/cm(5).m(5)) increased. The systolic index (4 4.25 +/- 11.01 ml/beat/m(2)) and the left ventricle work index (4.33 +/- 1. 29 kg.m/m(2)) also reduced. The mean pulmonary artery pressure (19.18 +/- 9 .21 mm Hg) and the right ventricle work index (0.94 +/- 0.62 mm Hg) remaine d elevated after the surgical procedure. CONCLUSIONS: The data allowed us to conclude that hepatosplenic schistosomi asis induces a hyperdynamic circulatory state that was corrected after sple nectomy and azygoportal disconnection, remaining a mild pulmonary hypertens ion. Therefore, these changes are correlated with the portosystemic collate ral circulation, especially as a consequence of splanchnic hyperflow. (Am J Gastroenterol 1999;94: 1632-1637. (C) 1999 by Am, Cell, of Gastroenterolog y).