Gallet B, Guérin Y, Saudemont J P, Hiltgen M
Service de cardiologie, Centre hospitalier Victor-Dupouy, Argenteuil.
Arch Mal Coeur Vaiss. 1987 Dec;80(13):1939-43.
The hypoxaemia associated with hepatic cirrhosis is classically attributed to an intrapulmonary shunt caused by small vascular abnormalities. Severe hypoxaemia (47 mmHg) associated with dyspnoea, cyanosis and clubbing was observed in a 57-year old man who presented with cirrhosis of the liver. At contrast echocardiography, a right-to-left shunt was demonstrated by the appearance of microcavities in the left atrium and ventricle after peripheral intravenous injection of the contrast medium. The intrapulmonary location of the shunt was determined by a 4 cardiac cycles interval between the arrival of the microcavities in the right heart and their appearance in the left heart. The right-to-left shunt was confirmed by the pure oxygen ventilation test and by pulmonary perfusion scintigraphy with radiolabelled albumin microaggregates. Pulmonary angiography proved normal. Thus, contrast echocardiography is capable of diagnosing right-to-left shunts associated with hepatic cirrhosis and to demonstrate their intrapulmonary location.
与肝硬化相关的低氧血症传统上归因于小血管异常导致的肺内分流。在一名患有肝硬化的57岁男性中观察到严重低氧血症（47 mmHg），伴有呼吸困难、发绀和杵状指。在对比超声心动图检查中，外周静脉注射造影剂后，左心房和心室内出现微泡，证实存在右向左分流。通过微泡到达右心与出现在左心之间的4个心动周期间隔来确定分流的肺内位置。纯氧通气试验和放射性标记白蛋白微聚体肺灌注闪烁显像证实了右向左分流。肺血管造影显示正常。因此，对比超声心动图能够诊断与肝硬化相关的右向左分流，并显示其肺内位置。
