[Hepatopulmonary syndrome].

Abstract

The hepatopulmonary syndrome (HPS) is a functional process which is characterized by the triad of liver cirrhosis, intrapulmonary vascular dilatations, and arterial hypoxemia in absence of detectable intrinsic disease of the lung and the heart. The pathophysiological foundation is the presence of a ventilation-perfusion (VA/Q) inequality based on marked vasodilatation of the pulmonary vessels at the precapillary level. Only in critically ill patients limitations of the diffusion of oxygen from the alveolar gas to the capillary blood and intrapulmonary arterio-venous communications will contribute increasingly to the hypoxemia. For diagnosis of HPS arterial blood gases (under condition of room air and 100% oxygen), contrast echocardiography, pulmonary angiography, and multiple inert gas elimination techniques will provide important informations. Regarding recent studies, liver transplantation is the treatment of choice in patients with severe HPS.