Portopulmonary hypertension echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Echocardiography

The diagnosis of portopulmonary hypertension is based on hemodynamic criteria:

1. . Portal hypertension and/or liver disease (clinical diagnosis—ascites/varices/splenomegaly)
2. . Mean pulmonary artery pressure—MPAP > 25 mmHg at rest
3. . Pulmonary vascular resistance—PVR > 240 dynes s cm−5
4. . Pulmonary artery occlusion pressure— PAOP < 15mmHg or transpulmonary gradient—TPG > 12 mmHg where TPG = MPAP − PAOP.

The diagnosis is usually first suggested by a transthoracic echocardiogram, part of the standard pre-transplantation work-up. Echocardiogram estimated pulmonary artery systolic pressures of 40 to 50 mm Hg are used as a screening cutoff for PPH diagnosis, with a sensitivity of 100% and a specificity as high as 96%.<ref name=Kim> The negative predictive value of this method is 100% but the positive predictive value is 60%.