Cardiac and renal effects of a transjugular intrahepatic portosystemic shunt in cirrhosis

Troels M Busk, Flemming Bendtsen, Søren Møller

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

30 Citationer (Scopus)

Abstract

Abstract
Refractory ascites and recurrent variceal bleeding are among the serious complications of portal hypertension and cirrhosis for which a transjugular intrahepatic portosystemic shunt (TIPS) can be used. Cirrhotic patients have varying degrees of haemodynamic derangement, mainly characterized by peripheral arterial vasodilatation, central underfilling and activation of several vasoactive systems. These changes affect the heart, the lungs and the kidneys in particular. The cardiac effects of TIPS are immediate and are related to the redirection of blood from the splanchnic circulation into the systemic circulation, resulting in worsening of the hyperdynamic circulation with increasing cardiac output and decreasing systemic vascular resistance; further, TIPS may unmask a latent diastolic dysfunction of the heart. However, the renal effects of TIPS seem to be beneficial as renal function tends to improve in patients with the hepatorenal syndrome. The clinical and haemodynamic effects of TIPS have been studied intensively and will be reviewed in the present paper. Considerable knowledge on the effects of TIPS on the pathophysiology of cirrhosis has been gained, but studies on the central haemodynamic effects are warranted to refine the already applied treatments and develop new treatment modalities.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Gastroenterology and Hepatology
Vol/bind25
Udgave nummer5
Sider (fra-til)523-530
Antal sider8
ISSN0954-691X
DOI
StatusUdgivet - 2013

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