Intrapulmonary arteriovenous shunt in children with chronic liver disease: clinical features, laboratory data and outcome.

OBJECTIVE To determine the frequency of hepatopulmonary syndrome in children with chronic liver disease, and its clinical and biochemical associations. METHOD This study included 53 children with chronic liver disease, who underwent contrast echocardiography with agitated saline and measurement of arterial blood gases. RESULTS Of the 53 patients studied, 18 had intrapulmonary shunting of blood. This shunting was associated with presence of palpable spleen, cyanosis and dyspnea, but not with abnormalities in the biochemical tests of liver function. At 1-year follow-up, there were 5 deaths among 18 patients with intrapulmonary shunt. In a logistic regression model, PaO 2 < 70 mmHg was found to be a predictor of death (p< 0.05). CONCLUSION Intrapulmonary shunting is a common and important complication in children with chronic liver disease.