Cardiorespiratory Emergencies, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, Hospital General de Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
Curr Probl Cardiol. 2022 Sep;47(9):101278. doi: 10.1016/j.cpcardiol.2022.101278. Epub 2022 Jun 4.
Centers for the research of patients with pulmonary hypertension (PH) usually perform right cardiac catheterization (RHC) to document this hemodynamic condition; traditionally, the procedure is performed by the interventional cardiologist, while the interventional radiologist generally conducts the study of hepatic hemodynamics. In our center, where the leading cause of catheterization of the hepatic veins is orthotopic liver transplantation, the cardio-pulmonologist performs the procedure to diagnose the possibility of porto-pulmonary hypertension and its implications. Routine measurement of the hepatic venous pressure gradient (HVPG) during RHC is not recommended but is performed to confirm the diagnosis of portal hypertension (PoH). Our objective in this review was to graphically describe the technique of hemodynamic recording of suprahepatic veins in patients with chronic liver disease and PoH who are in liver transplant protocol. The concepts included in this manuscript are measuring portal pressure, the definition of the hepatic venous pressure gradient (HVPG), procedures for a correct measurement of the HVPG, techniques associated with a suprahepatic vein catheterization, contraindications, and complications of HVPG, and clinical applications of HVPG. Clinically significant PoH is defined as an increase in GPVH ≥10 mmHg. HVPG measurement is currently the best available method for assessing the presence and severity of PoH. The RHC is the standard gold method for diagnosing PoPH that confirms its existence and provides additional data to exclude other causes of PAH in liver transplant candidates.
肺高血压（PH）患者研究中心通常进行右心导管检查（RHC）以记录这种血流动力学状况；传统上，该程序由介入心脏病专家执行，而介入放射科医生通常进行肝血流动力学研究。在我们的中心，肝静脉导管插入术的主要原因是原位肝移植，心肺科医生进行该程序以诊断门肺高血压的可能性及其影响。不建议在 RHC 期间常规测量肝静脉压力梯度（HVPG），但为了确认门静脉高压（PoH）的诊断而进行该测量。我们在本次综述中的目的是通过图形描述慢性肝病和 PoH 患者肝移植方案中肝静脉上方血管的血流动力学记录技术。本文包含的概念包括测量门静脉压力、肝静脉压力梯度（HVPG）的定义、正确测量 HVPG 的程序、与肝静脉上方导管插入术相关的技术、禁忌症和 HVPG 的并发症，以及 HVPG 的临床应用。临床上显著的 PoH 定义为 GPVH 增加≥10mmHg。HVPG 测量是目前评估 PoH 存在和严重程度的最佳方法。RHC 是诊断 PoPH 的标准金方法，它确认其存在并提供其他数据以排除肝移植候选者中肺动脉高压的其他原因。
