{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T23:41:30Z","timestamp":1791502890698,"version":"4.3.4"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","license":[{"start":{"date-parts":[[2015,9,1]],"date-time":"2015-09-01T00:00:00Z","timestamp":1441065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:p>Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (POPH) are pulmonary vascular complications of portal hypertension with divergent clinicopathologic features and management. The presence of intrapulmonary vascular dilatations (IPVDs), detected by agitated saline contrast\u2010enhanced transthoracic echocardiography (cTTE), is an essential feature of HPS but is not typically characteristic of POPH. Although IPVDs have been reported rarely in POPH, the prevalence and significance of this finding have not been systematically studied. We conducted a retrospective chart review of 80 consecutive patients diagnosed with POPH from January 1, 2002 to June 30, 2014 with documentation of cTTE findings, pulmonary hemodynamics, oxygenation, and survival. A total of 34 of the 80 patients (42%) underwent cTTE during initial diagnosis of POPH. IPVDs were detected in 20\/34 patients (59%); intracardiac shunting was detected in 9\/34 patients (26%; 4 also had IPVDs); and 9 patients (26%) had negative cTTE with no evidence of IPVD or intracardiac shunting. Patients with IPVD had decreased survival as compared to those without IPVD (<jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.003), a trend that persisted after exclusion of liver transplant recipients (<jats:italic toggle=\"yes\">P\u2009=\u2009<\/jats:italic> 0.07). The IPVD group had a trend toward higher Model for End\u2010Stage Liver Disease score with and without incorporating sodium (MELD or MELD\u2010Na; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.05 for both). The right ventricular index of myocardial performance (RIMP) was lower in the IPVD group (median, 0.4 versus 0.6; <jats:italic toggle=\"yes\">P<\/jats:italic>\u2009=\u20090.006). Patients with moderate or large IPVDs (n\u2009=\u20096) had worse oxygenation parameters (partial pressure of arterial oxygen, diffusing capacity of the lung for carbon monoxide, and alveolar\u2010arterial oxygen gradient) as compared to the rest of the cohort. Unexpectedly, IPVDs were frequently documented in POPH and associated with decreased survival. To further understand this observation, we recommend screening for IVPD in all patients with POPH. <jats:italic toggle=\"yes\">Liver Transpl 21:1355\u20101364, 2015<\/jats:italic>. \u00a9 2015 AASLD.<\/jats:p>","DOI":"10.1002\/lt.24198","type":"journal-article","created":{"date-parts":[[2015,6,16]],"date-time":"2015-06-16T07:24:50Z","timestamp":1434439490000},"page":"1355-1364","source":"Crossref","is-referenced-by-count":49,"title":["Intrapulmonary vascular dilatations are common in portopulmonary hypertension and may be associated with decreased survival"],"prefix":"10.1097","volume":"21","author":[{"given":"Lynn A.","family":"Fussner","sequence":"first","affiliation":[{"name":"Divisions of Pulmonary and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek N.","family":"Iyer","sequence":"additional","affiliation":[{"name":"Divisions of Pulmonary and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Cartin\u2010Ceba","sequence":"additional","affiliation":[{"name":"Divisions of Pulmonary and Critical Care Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Lin","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases, Mayo Clinic,Rochester,Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kymberly D.","family":"Watt","sequence":"additional","affiliation":[{"name":"Divisions of Gastroenterology and Hepatology,Mayo Clinic Transplant Center,Rochester,Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Krowka","sequence":"additional","affiliation":[{"name":"Divisions of Pulmonary and Critical Care Medicine"},{"name":"Divisions of Gastroenterology and Hepatology,Mayo Clinic Transplant Center,Rochester,Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2015,10,12]]},"reference":[{"key":"lt24198-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1183\/09059180.00007211","article-title":"Portopulmonary hypertension and hepatopulmonary syndrome: a clinician\u2010oriented overview","volume":"21","year":"2012","journal-title":"Eur Respir Rev"},{"key":"lt24198-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1378\/chest.123.2.562","article-title":"Portopulmonary hypertension: a tale of two circulations","volume":"123","year":"2003","journal-title":"Chest"},{"key":"lt24198-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1002\/hep.26070","article-title":"Hepatopulmonary syndrome: favorable outcomes in the MELD exception era","volume":"57","year":"2013","journal-title":"Hepatology"},{"key":"lt24198-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1002\/hep.20658","article-title":"Natural history of hepatopulmonary syndrome: Impact of liver transplantation","volume":"41","year":"2005","journal-title":"Hepatology"},{"key":"lt24198-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1183\/09031936.04.00010904","article-title":"Pulmonary\u2010hepatic vascular disorders (PHD)","volume":"24","year":"2004","journal-title":"Eur Respir J"},{"key":"lt24198-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1016\/S0140-6736(04)16107-2","article-title":"Portopulmonary hypertension and hepatopulmonary syndrome","volume":"363","year":"2004","journal-title":"Lancet"},{"key":"lt24198-bib-0007-20240115","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/S0002-9440(10)65137-1","article-title":"Three\u2010dimensional reconstruction of pulmonary arteries in plexiform pulmonary hypertension using cell\u2010specific markers. 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