Demonstration of Right-to-Left Intrapulmonary Shunts in Chronic Liver Patients by Contrast Echocardiography

Contrast echocardiography is a useful method to show right-to-left intrapulmonary shunts in chronic hepatic diseases. This study sought the incidence of intrapulmonary shunts in patients with chronic liver disease. The study group consisted of 45 subjects (31 male and 14 female) with ages between 19 and 67. A total of 4 times 10 cc of physiologic saline solution and 40 mg furosemide bolus were injected through a peripheral vein to patients having sufficient echocardiographic view. To increase the intraabdominal pressure. Valsalva maneuver was performed. In apical four-chamber view, 4-6 beats following the presence of contrast material in the right heart, if passage of microbubles to the left was observed, contrast echocardiography was regarded as positive. In 7 of the 45 subjects (16%) contrast echoardiography was positive in varying degrees. No significant relation existed between the presence of contrast echocardiography and the age, sex, PaO2, etiology and duration of the disease, width of the portal vein and presence of esophageal varices. We concluded that positive contrast echocardiography in chronic liver disease is an indirect indicator of intrapulmonary shunts.