Right-sided heart failure as a first presentation of portopulmonary hypertension

Introduction. Pulmonary artery hypertension and right ventricular failure are potentially fatal complications that can develop in patients with portal hypertension. The objective of this case report was to report a patient with end stage liver disease, and portal and pulmonary artery hypertension and right heart failure. Case outline A 57-year-old man was admitted to the Cardiology Department of tertiary hospital due to signs of right sided heart failure, ascites, pleural effusions, and pretibial edema. The patient had the history of alcohol abuse, arterial hypertension and gout. Just prior to the admission, abdominal ultrasound revealed granular liver structure, as well as ascites. Laboratory tests showed microcytic anemia, values of transaminases below referent, hypoalbuminemia, low creatinine clearance. Echocardiography revealed pulmonary hypertension (PH) and right ventricle failure. Right heart catheterization unraveled precapillary PH, but thoracic CT scan and thoracocentesis excluded underlying pulmonary illness. Treatment continued at Gastroenterology department of tertiary hospital. Abdominal CT scan diagnosed cirrhotic liver, and signs of portal hypertension. The patient was treated with symptomatic therapy, but develop acute on chronic renal failure and eventually died. Conclusion. Multidisciplinary approach is very important to distinguish portopulmonary hypertension early in the course of liver disease, because evolution of right sided heart failure precludes these patients from adequate lifesaving therapy.