Pathologic Intracardiac Bubbles in Patients With Cirrhosis: The Case for an Intestinal Origin

摘要

class="kwd-title">Keywords: Microbubbles, Cirrhosis, Portosystemic shunt, Hepatopulmonary syndrome class="head no_bottom_margin" id="sec1title">IntroductionMicrobubbles may be detected in the heart in the absence of an active infusion. Bubbles may form in the vicinity of prosthetic valves because local pressure drop causes gas to separate from liquid, which is called degassing. Spontaneous microbubbles have also been described in the setting of congestive heart failure, mitral valvular disease, tricuspid regurgitation, pulmonary hypertension, and pulmonary embolism., , These bubbles may have a gastrointestinal origin and be pathologic rather than spontaneous. Abraham et al described bilateral intracardiac bubbles on transthoracic echocardiography in a neonate with complete atrioventricular septal defect, no active intravenous infusion, and radiographic pneumatosis intestinalis. Subcostal imaging showed portal vein and hepatic vein bubbles streaming into the inferior vena cava (IVC). Labbé and Hafiani described a 78-year-old man with a central line clear of air, bilateral echocardiographic intracardiac bubbles, and computed tomographic findings of portal vein gas and intestinal pneumatosis.Liver disease may also be associated with pathologic intracardiac bubbles. Akasaka et al described microbubbles in eight patients, three with prosthetic valves and six with liver disease. In one patient, portal and mesenteric vein bubbles were noted and illustrated on M-mode echocardiography. Portal vein bubbles may reach both sides of the heart because of distinct pathophysiology associated with severe liver disease. To illustrate this, we present findings in two patients with cirrhosis.