Criteria for Grading the Severity of Portopulmonary Hypertension

Description

The severity of portpulmonary hypertension can be graded based on certain clinical criteria.

Parameters:

(1) NYHA functional class

(2) mean pulmonary arterial pressure in mm Hg

(3) cardiac index in liters per minute per square meter BSA

(4) pulmonary vascular resistance in dynes per second • cm^(-5)

(5) right atrial pressure in mm Hg

Parameter	Finding	Severity Grade
functional class	normal	normal
	NYHA I	mild
	NYHA II	mild or moderate
	NYHA III	moderate or severe
	NYHA IV	severe
mean pulmonary arterial pressure	15 to 24 mm Hg	normal
	25 to 34 mm Hg	mild
	35 to 44 mm Hg	moderate
	>= 45 mm Hg	severe
cardiac index	2.5 to 4.0	normal to moderate
	2.0 to 2.49	moderate
	< 2.0	severe
pulmonary vascular resistance	< 240	normal
	240 - 500	mild
	500 - 800	moderate
	> 800	severe
right atrial pressure	0 to 5	normal or mild
	5 to 8	moderate
	> 8	severe

where:

• There was no entry in the table for cardiac index in range of 2.0 to 2.49 liters per minute per square meter BSA. I added this to fill the gap.

• The authors state that some clinicians use the upper limit of normal for pulmonary vascular resistance in the presence of liver disease as 120 dyne per second • cm^(-5)

Interpretation:

• Mild portopulmonary hypertension has a favorable. It will reverse after liver transplantation.

• Moderate portopulmonary hypertension has a fair prognosis. It may or may not reverse after liver transplantation.

• Severe portpulmonary hypertensions has a poor prognosis. It does not reverse after liver transplantation.

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Criteria for Grading the Severity of Portopulmonary Hypertension

Description

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