Diagnosis of hepatopulmonary syndrome with contrast transesophageal echocardiography: advantages over contrast transthoracic echocardiography.

The aim of this study was to study theprevalence of hepatopulmonary syndrome (HPS) incirrhotic patients, comparing the results obtained usingcontrast transthoracic echocardiography (CTTE) andcontrast transesophageal echocardiography (CTEE) in thedemonstration and grading of pulmonary vasodilatation(PV). We also analyzed the correlation betweengas-exchange abnormalities and PV when it wasdemonstrated with both techniques. The prevalence of PV andHPS with CTEE in the 88 cirrhotic patients was 28% and22%, respectively, and with CTEE, 42% (P < 0.05)(middle PV: 35% and significant PV: 7%) and 30% (P < 0.05), respectively. Fifty-six percentof patients diagnosed with PV and with CTTE presentedwith hypoxemia as did 49% using CTEE (83% of patientswith significant PV had hypoxaemia). PaCO and diffusing capacity of CO were significantly moredecreased in 2 patients with PV than in patients withoutPV when CTEE was employed. We conclude that CTEE issuperior to CTTE in the diagnosis and grading of PV in the diagnosis of HPS in cirrhotic patients,being more sensitive and presenting a better correlationwith gas-exchange abnormalities. Given its highsensitivity, CTEE should be carried out in all patients with suspicion of HPS and normal or uncertainCTTE.