Left Ventricular Dilation and Pulmonary Vasodilatation after Surgical Shunt for Treatment of Pre-Sinusoidal Portal Hypertension.

Orlando Luis De Andrade Santarém,Marianna Siqueira De Assumpção,Paulo Herman,Roberto De Cleva,Flávia Megumi Sasaya,Alfonso Julio Guedes Barbato,Meive Santos Furtado,Vincenzo Lionetti

doi:10.1371/journal.pone.0154011

Orlando Luis De Andrade Santarém, Marianna Siqueira De Assumpção + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0154011

Copy DOI

Journal: PloS one	Publication Date: Apr 27, 2016
Citations: 3	License type: CC BY 4.0

Affiliation: Universidade de São Paulo

Abstract

ObjectiveThe aim of this study was to prospectively investigate the long-term cardiovascular and pulmonary hemodynamic effects of surgical shunt for treatment of portal hypertension (PH) due to Schistosomiasis mansoni.LocationThe University of São Paulo Medical School, Brazil; Public Practice.MethodsHemodynamic evaluation was performed with transesophageal Doppler and contrast-enhanced echocardiography (ECHO) on twenty-eight participants with schistosomal portal hypertension. Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1—distal splenorenal shunt (DSRS, n = 13) and group 2—esophagogastric devascularization and splenectomy (EGDS, n = 15).ResultsThe cardiac output (5.08 ± 0.91 L/min) and systolic volume (60.1 ± 5.6 ml) were increased (p = 0.001) in the DSRS group. DSRS participants had a significant increase (p < 0.0001) in their left ventricular end-systolic and end-diastolic diameters as well as in their left ventricular end-diastolic and end-systolic volumes (p < 0.001) compared with the preoperative period. No statistically significant difference was found in the patients who underwent EGDS. ECHO revealed intrapulmonary vasodilatation (IPV) in 18 participants (64%), 9 DSRS and 9 EGDS (p > 0.05).ConclusionsThe late increase in the cardiac output, stroke volume and left ventricular diameters demonstrated left ventricular dilatation after a distal splenorenal shunt. ECHO revealed a greater prevalence for IPV in patients with schistosomiasis than has previously been described in patients with PH from liver cirrhosis.

Highlights

Schistosoma mansoni is the major infectious agent of schistosomiasis, an endemic disease primarily found in tropical areas and Brazil
Participants were divided into two groups according to the surgical procedure used to treat their schistosomal portal hypertension within the last two years: group 1—distal splenorenal shunt (DSRS, n = 13) and group 2—esophagogastric devascularization and splenectomy (EGDS, n = 15)
ECHO revealed a greater prevalence for intrapulmonary vasodilatation (IPV) in patients with schistosomiasis than has previously been described in patients with portal hypertension (PH) from liver cirrhosis

Summary

Introduction

Schistosoma mansoni is the major infectious agent of schistosomiasis, an endemic disease primarily found in tropical areas and Brazil. Schistosomiasis, in its most severe form, can lead to a presinusoidal portal hypertension with minimal hepatic dysfunction and marked splenomegaly [2,3]. The leading cause of morbidity and mortality in mansonic schistosomiasis is esophageal bleeding from varices rupture [4,5,6], and surgical treatment of portal hypertension is the best therapeutic option [7,8]. DSRS is an effective treatment of portal hypertension (with low rebleeding rates), but it has high rates of postoperative portosystemic encephalopathy [9]. EGDS is a relatively simple technique with good results and the absence of postoperative encephalopathy, and it is the treatment of choice for the majority of groups undergoing treatment of schistosomiasis presinusoidal portal hypertension [5,9,10]

Methods

Results

Conclusion