Síndrome hepatopulmonar: actualización de los avances recientes de fisiopatología, investigación y tratamiento.
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Hepatopulmonary syndrome: update on recent advances in pathophysiology, investigation, and treatment.
Grace JA, Angus PW.
Department of Medicine, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia. j.grace4@pgrad.unimelb.edu.au
J Gastroenterol Hepatol. 2013 Feb;28(2):213-9. doi: 10.1111/jgh.12061.
Abstract
Hepatopulmonary syndrome (HPS) is an important cause of dyspnea and hypoxia in the setting of liver disease, occurring in 10-30% of patients with cirrhosis. It is due to vasodilation and angiogenesis in the pulmonary vascular bed, which leads to ventilation-perfusion mismatching, diffusion limitation to oxygen exchange, and arteriovenous shunting. There is evidence, primarily from animal studies, that vasodilation is mediated by a number of endogenous vasoactive molecules, including endothelin-1 and nitric oxide (NO). In experimental HPS, liver injury stimulates release of endothelin-1 and results in increased expression of ET(B) receptors on pulmonary endothelial cells, leading to upregulation of endothelial NO synthase (eNOS) and subsequent increased production of NO, which causes vasodilation. In addition, increased phagocytosis of bacterial endotoxin in the lung not only promotes stimulation of inducible NO synthase, which increases NO production, but also contributes to intrapulmonary accumulation of monocytes, which may stimulate angiogenesis via vascular endothelial growth factor pathway. Despite these insights into the pathogenesis of experimental HPS, there is no established medical therapy, and liver transplantation remains the main treatment for symptomatic HPS, although selected patients may benefit from other surgical or radiological interventions. In this review, we focus on recent advances in our understanding of the pathophysiology of HPS, and discuss current approaches to the investigation and treatment of this condition.
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Tratamiento farmacológico del síndrome hepatopulmonar
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Pharmacological treatment for hepatopulmonary syndrome.
Eshraghian A, Kamyab AA, Yoon SK.
Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Biomed Res Int. 2013;2013:670139. doi: 10.1155/2013/670139. Epub 2013 Sep 12.
Abstract
AIM: Hepatopulmonary syndrome is a pulmonary dysfunction in the context of liver cirrhosis characterized by arterial deoxygenation. Affected patients have increased morbidity and mortality, and many of them expire before undergoing liver transplantation. Therefore, finding medical therapy as a bridge to transplantation or as a final treatment is necessary. In this study, we aimed to review the current literature about pharmacological options available for treatment of hepatopulmonary syndrome. METHODS:A PubMED and Scopus search was conducted in January 2013 on the English literature published in any time period to find human and animal studies reporting pharmacological therapy of hepatopulmonary syndrome. RESULTS: Out of 451 studies, 29 relevant articles were included. The number of patients, type, dose, duration, and mechanism of drugs in these studies was extracted and summarized separately. Most of pharmacologic agents act through inhibition of nitric oxide synthase and reduction in nitric oxide production, inactivation of endothelin-1, and treatment of bacterial translocation and pulmonary angiogenesis. CONCLUSION: Several drugs have been applied for the treatment of HPS with conflicting results. However, no large randomized trial has been conducted probably due to low number of patients. Multicentered clinical trials are necessary to investigate these drugs.
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Síndrome hepatopulmonar: consideraciones anestésicas
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Hepatopulmonary syndrome: the anaesthetic considerations.
Fauconnet P, Klopfenstein CE, Schiffer E.
From the Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Eur J Anaesthesiol. 2013 Dec;30(12):721-30. doi: 10.1097/EJA.0b013e328365bb6f
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