Abstract:
AIM:To investigate the systemic hemodynamic effects of two surgical procedures largely employed for treatment of schistosomal portal hypertension. METHODS:Thirty-six patients undergoing elective surgical treatment of portal hypertension due to hepatosplenic mansonic schistosomiasis were prospectively evaluated. All patients were subjected to preoperative pulmonary artery catheterization; 17 were submitted to esophagogastric devascularization and splenectomy (EGDS) and 19 to distal splenorenal shunt (DSRS). The systemic hemodynamic assessment was repeated 4 d after the surgical procedure. RESULTS:Preoperative evaluation revealed (mean +/- SD) an increased cardiac index (4.78 +/- 1.13 L/min per m(2)), associated with a reduction in systemic vascular resistance index (1457 +/- 380.7 dynes.s/cm(5).m(2)). The mean pulmonary artery pressure (18 +/- 5.1 mmHg) as well as the right atrial pressure (7.9 +/- 2.5 mmHg) were increased, while the pulmonary vascular resistance index (133 +/- 62 dynes x s/cm(5) x m(2)) was decreased. Four days after EGDS, a significant reduction in cardiac index (3.80 +/- 0.4 L/min per m(2), P < 0.001) and increase in systemic vascular resistance index (1901.4 +/- 330.2 dynes x s/cm(5) x m(2), P < 0.001) toward normal levels were observed. There was also a significant reduction in pulmonary artery pressure (12.65 +/- 4.7 mmHg, P < 0.001) and no significant changes in the pulmonary vascular resistance index (141.6 +/- 102.9 dynes x s/cm(5) x m(2)). Four days after DSRS, a non-significant increase in cardiac index (5.2 +/- 0.76 L/min per m(2)) and systemic vascular resistance index (1389 +/- 311 dynes x s/cm(5) x m(2)) was observed. There was also a non-significant increase in pulmonary artery pressure (19.84 +/- 5.2 mmHg), right cardiac work index (1.38 +/- 0.4 kg x m/m(2)) and right ventricular systolic work index (16.3 +/- 6.3 g x m/m(2)), without significant changes in the pulmonary vascular resistance index (139.7 +/- 67.8 dynes xs/cm(5) x m(2)). CONCLUSION:The hyperdynamic circulatory state observed in mansonic schistosomiasis was corrected by EGDS, but was maintained in patients who underwent DSRS. Similarly, the elevated mean pulmonary artery pressure was corrected after EGDS and maintained after DSRS. EGDS seems to be the most physiologic surgery for patients with schistosomal portal hypertension.
journal_name
World J Gastroenteroljournal_title
World journal of gastroenterologyauthors
de Cleva R,Herman P,D'albuquerque LA,Pugliese V,Santarem OL,Saad WAdoi
10.3748/wjg.v13.i41.5471subject
Has Abstractpub_date
2007-11-07 00:00:00pages
5471-5issue
41eissn
1007-9327issn
2219-2840journal_volume
13pub_type
杂志文章,随机对照试验abstract:AIM:To investigate the relationship between certain biochemical parameters of lipid metabolism in the serum and steatosis in the liver. METHODS:The grade of steatosis (0-3) and histological activity index (HAI, 0-18) in liver biopsy specimens were correlated with serum alanine aminotransferase (ALT), total cholesterol...
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pub_type: 杂志文章
doi:10.3748/wjg.v11.i41.6422
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 社论,评审
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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更新日期:2007-02-14 00:00:00
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pub_type: 杂志文章
doi:10.3748/wjg.v25.i4.433
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pub_type: 杂志文章,评审
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.15.4037
更新日期:2009-08-28 00:00:00
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pub_type: 杂志文章
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更新日期:2005-03-07 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2011-06-14 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v13.i47.6446
更新日期:2007-12-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 社论,评审
doi:10.3748/wjg.15.4097
更新日期:2009-09-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 评论,杂志文章
doi:10.3748/wjg.v19.i6.797
更新日期:2013-02-14 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 评论,信件
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更新日期:2009-11-14 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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pub_type: 杂志文章
doi:10.3748/wjg.v3.i2.122
更新日期:1997-06-15 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v20.i29.10208
更新日期:2014-08-07 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
doi:10.3748/wjg.v20.i30.10338
更新日期:2014-08-14 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
doi:10.3748/wjg.v21.i23.7233
更新日期:2015-06-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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更新日期:2010-01-21 00:00:00
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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journal_title:World journal of gastroenterology
pub_type: 杂志文章,评审
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journal_title:World journal of gastroenterology
pub_type: 杂志文章
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pub_type: 杂志文章
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更新日期:2013-03-14 00:00:00