A case of portopulmonary hypertension successfully treated by balloon-occluded retrograde transvenous obliteration and home oxygen therapy

Abstract

A 71-year-old man was admitted to our hospital due to dyspnea on effort and recurrent esophageal varices. In right heart catheterization, mean pulmonary arterial pressure was raised to 36mmHg, suggesting pulmonary arterial hypertension. He had hepatitis C virus-related cirrhosis of the liver and portal hypertension, but had no other causes of pulmonary arterial hypertension, leading to the diagnosis of portopulmonary hypertension. He had undergone balloon-occluded retrograde transvenous obliteration for esophageal varices four months ago, and it resulted in a 9.3%-reduction of the mean pulmonary arterial pressure, estimated by echo cardiography, but he was still suffering from dyspnea and hypoxia. We then introduced home oxygen therapy, which showed an effect of further 20.5%-reduction of the mean pulmonary arterial pressure four months later. Thus our present case provides some important clues to pathogenesis as well as treatment of portopulmonary hypertension.