Department of Gastroenterology, Royal Bolton Hospital, Lancashire, Bolton BL4 0JR, UK.
Eur J Gastroenterol Hepatol. 2010 Feb;22(2):241-5. doi: 10.1097/MEG.0b013e32833110f7.
In this study, we describe the development of acute pulmonary oedema and cardiac arrest after therapeutic ascitic paracentesis, in a gentleman with decompensated liver cirrhosis. There was no previous history of cardiorespiratory symptoms or disease. Postmortem examination revealed oedematous and congested lungs with bilateral pleural effusions; in addition, the right heart was dilated and congested. Micronodular cirrhosis was present with histological features of alpha1 antitrypsin deficiency. This is the first study of acute cardiac decompensation after large volume paracentesis. Owing to the postmortem findings, underlying asymptomatic cardiorespiratory disease may have been present. Cirrhosis is associated with cardiovascular complications including cirrhotic cardiomyopathy, portopulmonary hypertension and hepatopulmonary syndrome which may manifest or worsen under situations of haemodynamic stress. This report thus raises the question whether routine screening for cardiovascular abnormalities is warranted in patients with decompensated cirrhosis, particularly before the procedures such as paracentesis that impose significant haemodynamic strain.
在这项研究中，我们描述了一位代偿期肝硬化男性在接受治疗性腹腔穿刺后发生急性肺水肿和心脏骤停的情况。他以前没有心肺症状或疾病史。尸检显示肺部水肿和充血，双侧胸腔积液；此外，右心扩张和充血。存在微结节性肝硬化，具有α1抗胰蛋白酶缺乏的组织学特征。这是首例大容量腹腔穿刺后急性心功能不全的研究。由于尸检结果，可能存在无症状的心肺疾病。肝硬化与心血管并发症有关，包括肝硬化心肌病、门肺高压和肝肺综合征，这些并发症在血流动力学应激下可能表现出来或恶化。因此，本报告提出了一个问题，即在进行大量腹腔穿刺等显著影响血流动力学的操作之前，是否有必要对失代偿期肝硬化患者进行心血管异常的常规筛查。
