AlteraÃÃes vasculares pulmonares em pacientes com fibrose periportal esquistossomÃtica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2008

RESUMO

Background: Mansonic schistosomiasis is an endemic disease in Brazil and can cause disease in different organs The pulmonary vascular pathology, one of the most severe clinical manifestations of this disease, consists mainly of pulmonary arterial hypertension (PAH) and cyanotic syndrome. The PAH is defined by an artery systolic pressure >35mmHg, or mean >25mmHg at rest or >30mmHg with exercise. Today, the cyanotic syndrome may be recognized like hepatopulmonary syndrome (HPS), characterized by liver disease or portal hypertension, hypoxemia and intrapulmonary vascular dilatations (IPVD). Transthoracic echodopplercardiogram (TTE) provides a sensitive and noninvasive method to investigate PAH, and using microbubble contrast, it could detect IPVD or arteriovenous fistula. Objectives: To determine the prevalence of PH and HPS in patients with schistosomal periportal fibrosis attended at Hospital das ClÃnicas â Universidade Federal de Pernambuco. Method: 84 patients with schistosomal periportal fibrosis attended between April and July of 2007, age between 18 and 70 years, were enrolled and submitted to arterial blood gas analysis and TTE. Contrast enhanced TTE was carried out in patients with D(A-a)O2≥15mmHg. Patients with PH and HPS were submitted to thorax multidetector row computerized tomography (MDCT). Results: The prevalence of PH in patients with schistosomal periportal fibrosis was 10,7% (IC: 5.02-19,37) (9 patients) . The MDCT findings were: larger diameter of pulmonary artery trunk (66,6%), ratio of the diameter of the pulmonary artery trunk to the diameter of the ascending aorta more the 1:1 (55,5%), main pulmonary arteries dilatation (100%), ratio of the segmental arterial diameter to the adjacent bronchial diameter larger than 1:1 (88,8%), tapering of peripheral pulmonary arteries and cardiac enlargement (77,7%). None patient had pulmonary embolism by this method. These findings are presented in the article 1: Prevalence of Pulmonary Hypertension in Patients with Schistosomal Periportal Fibrosis Attended at Hospital das ClÃnicas â Universidade Federal de Pernambuco. Twenty two patients (26,19%) of the 84 patients presented D(A-a)O2 ≥15mmHg and were submitted to contrast enhanced TTE, and five patients showed IPVD, defining an HPS prevalence of 6% (IC: 1,96-13,35) in the studied population (5/84). The findings of MDCT in these patients were: dilated peripheral pulmonary vasculature (100%), ratio of the segmental arterial diameter to the adjacent bronchial diameter larger the one (100%), highest number of peripheral branches extending to pleural surface (40%) and micronodules associated to subpleural centrilobular vessels (40%). None patient had evidence of arteriovenous fistula. These findings are presented in the article 2: Prevalence of Hepatopulmonary Syndrome in Patients with Schistosomal Periportal Fibrosis Attended at Hospital das ClÃnicas âUniversidade Federal de Pernambuco. Conclusion: The prevalence of PH in was 10,7% and the prevalence of HPS was 6% in patients with schistosomal periportal fibrosis

ASSUNTO(S)

pneumologia esquistossomose sÃndrome hepatopulmonar tomography hipertensÃo pulmonar pulmonary hypertension schistosomiasis tomografia computadorizada por raios x ecocardiografia echocardiography x ray computed hepatopulmonary syndrome

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