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World J Gastroenterol. Nov 7, 2007; 13(41): 5471-5475
Published online Nov 7, 2007. doi: 10.3748/wjg.v13.i41.5471
Pre- and postoperative systemic hemodynamic evaluation in patients subjected to esophagogastric devascularization plus splenectomy and distal splenorenal shunt: A comparative study in schistomomal portal hypertension
Roberto de Cleva, Paulo Herman, Luis Augusto Carneiro D'albuquerque, Vincenzo Pugliese, Orlando Luis Santarem, William Abrão Saad
Roberto de Cleva, Paulo Herman, Luis Augusto Carneiro D'albuquerque, Vincenzo Pugliese, Orlando Luis Santarem, William Abrão Saad, Gastroenterology Department, University of São Paulo Medical School, São Paulo, SP 05403-900, Brazil
Author contributions: All authors contributed equally to the work.
Correspondence to: Roberto de Cleva, Gastroenterology Department, University of São Paulo Medical School, Rua Cel. Artur Godoy 125, Apto 152. Vila Mariana, São Paulo, SP 04018-050, Brazil. roberto.cleva@hcnet.usp.br
Telephone: +55-11-32842831 Fax: +55-11-32842831
Received: October 10, 2006
Revised: July 28, 2007
Accepted: August 27, 2007
Published online: November 7, 2007
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 m2), associated with a reduction in systemic vascular resistance index (1457 ± 380.7 dynes.s/cm5.m2). 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.s/cm5.m2) was decreased. Four days after EGDS, a significant reduction in cardiac index (3.80 ± 0.4 L/min per m2, P < 0.001) and increase in systemic vascular resistance index (1901.4 ± 330.2 dynes.s/cm5.m2, 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.s/cm5.m2). Four days after DSRS, a non-significant increase in cardiac index (5.2 ± 0.76 L/min per m2) and systemic vascular resistance index (1389 ± 311 dynes.s/cm5.m2) 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.m/m2) and right ventricular systolic work index (16.3 ± 6.3 g.m/m2), without significant changes in the pulmonary vascular resistance index (139.7 ± 67.8 dynes.s/cm5.m2).

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.

Keywords: Pulmonary Hypertension; Hyperdynamic circulation; Portal Hypertension; Splenectomy; Cardiomyopathy