Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis

Abstract

Abstract: Objective To investigate the application value of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis. Methods One hundred and eigthy-six inpatients with liver cirrhosis admitted to our hospital from July 2019 to September 2019 underwent the right heart contrast echocardiography, and vitamin B6 and sodium bicarbonate were used as contrast agents. The adverse reactions during the inspection were recorded. The dynamic images were collected. The image with the most densest area of microbubble in left atrium of patients with intrapulmonary shunt was analyzed, and the amount of microbubbles was semi-quantitatively analyzed to evaluate the existence of intrapulmonary vascular shunt. The right-heart contrast echocardiography and clinical data of patients with intrapulmonary shunt were analyzed to evaluate the high-risk factors. Results Among the 186 patients, 125 were males (67.2%) and 61 were females (32.8%), patients mean age ranged from 26 to 70 years old (53.4±9.9 years old). All patients had a good tolerance, and only 2 patients felt slight pain at the injection site, with no effect on the experiment. No adverse events occurred. 4 cases (2.15%) with a large volume of shunt, 6 cases with a medium volume of shunt (3.22%), 38 cases (20.43%) with a small volume of shunt, and 138 cases (74.19%) with no intrapulmonary shunt. Compared to the patients with a small volume of shunt, the appearance of microbubbles in the left atrium was earlier in patients with a large volume of shunt after contrast agents were injected. Further analysis showed that the Spearman correlation coefficient between the volume of the pulmonary shunt and the degree of cirrhosis in patients with liver cirrhosis was 0.463, which was a positive correlation. The volume of the intrapulmonary shunt became larger as the Child-Pugh grade of liver cirrhosis got higher. Conclusion The vitamin B6 and sodium bicarbonate mixed liquors can be a safe and effective contrast agent used in patients with liver cirrhosis for right-heart contrast echocardiography. The volume of intrapulmonary shunt is closely related to the severity of hepatic cirrhosis in patients with liver cirrhosis.

Key words: Liver cirrhosis, Hepatopulmonary syndrome, Right heart echocardiography, Vitamin B6, Sodium bicarbonate

PAN Guo-dong, HOU Fei, ZHANG Yao, LIU Yu-feng, WANG Xiao-jing, LIU Yao, DUAN Ying, WANG Yan-bin, LI Wei, HAO Yi-wei, XIONG Hao-feng. Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(9): 972-976.

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