contrast enhanced echocardiography for detection of intrapulmonary shunts in liver transplant candidates

background: intrapulmonary vascular abnormalities associated with liver cirrhosis may result in intrapulmonary right-to-left shunt and hypoxemia. the aim of this study was to use contrast enhanced echocardiography to detect intrapulmonary vascular abnormalities in patients with liver cirrhosis candidates for liver transplantation.   methods: one hundred and two adult patients underwent contrast enhanced echocardiography to determine the prevalence of intrapulmonary right-to-left shunt and its relationship to the severity of hepatic disease, arterial oxygenation, and spider angioma.   results: the rate of patients with positive and negative contrast enhanced echocardiography was 44% and 56%, respectively. there was no significant difference in age, sex, or etiology of liver cirrhosis in patients with and without intrapulmonary shunt. patients with intrapulmonary right-to-left shunt had more severe hepatic disease compared with those without shunt (child-pugh score 12±2 vs 8±2). there was significant difference in the partial arterial oxygen pressure (pao 2 ) values in patients with grade 3 + to 4 + left ventricular opacification by microbubbles compared with those without evidence of intrapulmonary right-to-left shunt (64±6 vs 82±10 mmhg). twenty eight of the patients with intrapulmonary right-to-left shunt had cutaneous spider angioma.   conclusion: the findings suggest that there was a significant relation between severity of liver cirrhosis and presence of intrapulmonary right-to-left shunt or severity of hypoxemia. the data also indicate that cirrhotic patients with cutaneous spider angioma most likely have the shunt.