The hepatopulmonary syndrome

• Published in: Arquivos brasileiros de cirurgia digestiva : ABCD 2014-06, Vol.27 (2), p.145-147
• Main Authors: NACIF, Lucas Souto, ANDRAUS, Wellington, PINHEIRO, Rafael Soares, DUCATTI, Liliana, HADDAD, Luciana BP, D'ALBUQUERQUE, Luiz Carneiro
• Format: Article
• Language: English
• Subjects: Hepatopulmonary syndrome; Liver transplantation; Review; Surgery
• ISSN: 0102-6720; 0102-6720; 2317-6326
• DOI: 10.1590/S0102-67202014000200012

INTRODUCTION: The hepatopulmonary syndrome has been acknowledged as an important vascular complication in lungs developing systemic hypoxemia in patients with cirrhosis and portal hypertension. Is formed by arterial oxygenation abnormalities induced from intrapulmonary vascular dilatations with liver disease. It is present in 4-32% of patients with cirrhosis. It increases mortality in the setting of cirrhosis and may influence the frequency and severity. Initially the hypoxemia responds to low-flow supplemental oxygen, but over time, the need for oxygen supplementation is necessary. The liver transplantation is the only effective therapeutic option for its resolution. AIM: To update clinical manifestation, diagnosis and treatment of this entity. METHOD: A literature review was performed on management of hepatopulmonary syndrome. The electronic search was held of the Medline-PubMed, in English crossing the headings "hepatopulmonary syndrome", "liver transplantation" and "surgery". The search was completed in September 2013. RESULTS: Hepatopulmonary syndrome is classically defined by a widened alveolar-arterial oxygen gradient (AaPO2) on room air (>15 mmHg, or >20 mmHg in patients >64 years of age) with or without hypoxemia resulting from intrapulmonary vasodilatation in the presence of hepatic dysfunction or portal hypertension. Clinical manifestation, diagnosis, classification, treatments and outcomes are varied. CONCLUSION: The severity of hepatopulmonary syndrome is an important survival predictor and determine the improvement, the time and risks for liver transplantation. The liver transplantation still remains the only effective therapeutic. INTRODUÇÃO: A síndrome hepatopulmonar (SHP) tem sido reconhecida como importante complicação vascular nos pulmões desenvolvendo hipoxemia sistêmica em pacientes com cirrose e hipertensão portal. Ela é formada pela presença de anormalidade na oxigenação arterial induzida por dilatações vasculares intrapulmonares com a doença hepática e está presente em 4-32% dos pacientes com cirrose. Aumenta a mortalidade no cenário de cirrose podendo influenciar na frequência e gravidade. Inicialmente, a hipoxemia nos pacientes com esta síndrome responde à suplementação com baixo fluxo de oxigênio; mas, ao longo do tempo, há necessidade de maior suplementação de oxigênio. O transplante de fígado é a única opção terapêutica eficaz para a resolução. OBJETIVO: Atualizar conhecimentos sobre a síndrome hepatopulmonar, suas manifestaçõe