J.Jpn. Surg. Soc.. 82(10): 1205-1211, 1981
Original article
PHYSIOLOGIC PULMONARY SHUNT BEFORE AND AFTER SURGICAL TREATMENT OF PORTAL HYPERTENSION (2nd Report)
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*) Department of Surgery, Ageo General Hospital Yukihiko Ohshima*), Hiromu Nemoto**), Koichi Aso**) |
Each internal pressure was measured by Swan-Ganz catheter. The physiologic pulmonary shunt, cardiac output, vascular resistance, closing volume, blood volume and pulmonary diffusing capacity for carbon monoxide were calculated and the ventilation: perfusion ratio was measured.
No reasonable differences could be found between the patients with idiopathic portal hypertension and liver cirrhosis. In the preoperative period, the physiologic pulmonary shunt rate, the means pulmonary artery pressure, cardiac output and closing volume increased in the cases of esophageal transection with paraesophageal devascularization. The pulmonary diffusing capacity for carbon monoxide was decreased while the vascular resistance and the ventilation: perfusion ratio were in the normal range.
On the other hand, postoperatively, the physiologic pulmonary shunt rate was improved. The cardiac output, mean pulmonary artery pressure and blood volume decreased. The closing volume and pulmonary diffusing capacity for carbon monoxide registered no change.
The increase in pulmonary physiologic pressure in patients with esophageal varices may be the effect of an increase in cardiac output, brought about by an increase in blood volume and others. The mean pulmonary artery pressure rose due to an increase of cardiac output and pulmonary interstitial edema, thus releasing the intrapulmonary and portopulmonary shunt. All of which seem to lead to an increase in the physiologic pulmonary shunt rate.
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