The use of two-dimensional contrast echocardiography in patients with portal hypertension for the detection of cardiac chamber abnormalities and pulmonary arteriovenous shunts

Abstract

To study the cardiac chamber abnormalities and presence of pulmonary arteriovenous shunts in patients with non-cirrhotic portal fibrosis (NCPF), two-diemensional echocardiography was carried out in 14 patients. Eleven patients with cirrhosis of the liver and seven patients with extrahepatic obstruction were also studied. No patient had organic heart disease, clinical cyanosis, significant anaemia, or features of hepatic decompensation. Significant enlargement of left atrial, left ventricular and right ventricular chambers was seen in 64%, 57% and 14% of NCPF patients, respectively. There was, however, no significant difference in the frequency of cardiac chamber enlargement in patients with NCPF compared with the other two groups of patients. Though reduced left ventricular ejection fraction (< 60% normal) was more commonly seen in patients with NCPF (35.7%) than in patients with cirrhosis (18.2%), the difference was not significant. No patient with extrahepatic obstruction had reduced ejection fraction. Except for one patient with cirrhosis, echocardiography with saline infusion failed to reveal intrapulmonary shunts in any patient. It is concluded that cardiac chamber abnormalities were seen in a significant proportion of patients with NCPF, but, none of them showed pulmonary arteriovenous shunts as studied by contrast echocardiography.