Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography - Advantages over contrast transthoracic echocardiography

The aim of this study was to study the prevalence of hepatopulmonary syndro me (HPS) in cirrhotic patients, comparing the results obtained using contra st transthoracic echocardiography (CTTE) and contrast transesophageal echoc ardiography (CTEE) in the demonstration and grading of pulmonary vasodilata tion (PV). We also analyzed the correlation between gas-exchange abnormalit ies and PV when it was demonstrated with both techniques. The prevalence of PV and HPS with CTEE in the 88 cirrhotic patients was 28% and 22%, respect ively, and with CTEE, 42% (P < 0.05) (middle PV: 35% and significant PV: 7% ) and 30% (P < 0.05), respectively. Fifty-six percent of patients diagnosed with PV and with CTTE presented with hypoxemia as did 49% using CTEE (83% of patients with significant PV had hypoxaemia). PaCO2 and diffusing capaci ty of CO were significantly more decreased in patients with PV than in pati ents without PV when CTEE was employed. We conclude that CTEE is superior t o CTTE in the diagnosis and grading of PV in the diagnosis of HPS in cirrho tic patients, being more sensitive and presenting a better correlation with gas-exchange abnormalities, Given its high sensitivity, CTEE should be car ried out in all patients with suspicion of LIPS and normal or uncertain CTT E.