Pulmonary hypertension associated with cirrhosis of the liver and with portacaval shunts

Pulmonary hemodynamics were studied in 11 patients with hepatic cirrhosis who had undergone surgical portal decompression several years earlier. Four of the patients had both clinical and physiological evidence of pulmonary hypertension; two others had mild, subclinical pulmonary hypertension. Autopsy examination of two patients who had clinical evidence of pulmonary hypertension revealed thickening of the small pulmonary arteries and multiple small pulmonary emboli. Before the portosystemic venous anastomosis was created, all of the patients had had normal cardiorespiratory performance. These studies suggest that emboli from the portal vein may have been involved in the genesis of the pulmonary hypertension in these patients. The role of surgical portal decompression is unclear. Retrospective studies of 70 clinical records and of 17 autopsy protocols in a similar group of patients did not clarify the role of the surgical decompression in the genesis of the pulmonary hypertension.