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(Circulation. 2009;119:1518-1523.)
© 2009 American Heart Association, Inc.

Vascular Medicine

Cardiopulmonary Manifestations of Hepatosplenic Schistosomiasis

Monica Lapa, MD; Bruno Dias, MD; Carlos Jardim, MD, PhD; Caio J.C. Fernandes, MD; Paulo M.M. Dourado, MD; Magda Figueiredo, MD; Alberto Farias, MD, PhD; Jeane Tsutsui, MD, PhD; Mario Terra-Filho, MD, PhD; Marc Humbert, MD, PhD; Rogerio Souza, MD, PhD

From the Pulmonary Department (M.L., B.D., C.J., C.J.C.F., M.T.-F., R.S.) and Cardiology Department (P.M.M.D., M.F., J.T.), Heart Institute, and Gastroenterology Department (A.F.), University of Sao Paulo Medical School, Sao Paulo, Brazil; and Université Paris-Sud 11 (M.H., R.S.), Pulmonary Department, Hôpital Antoine-Beclere, Clamart, France.

Correspondence to Rogerio Souza, MD, PhD, Pulmonary Hypertension Group, Pulmonary Department, Heart Institute, University of Sao Paulo Medical School, Av Dr Eneas de Carvalho Aguiar, 44, Sao Paulo, Brazil 05403-000. E-mail rogerio.souza{at}incor.usp.br

Received July 1, 2008; accepted December 9, 2008.

Background — Schistosomiasis is a highly prevalent disease with >200 million infected people. Pulmonary hypertension is one of the pulmonary manifestations in this disease, particularly in its hepatosplenic presentation. The aim of this study was to determine the prevalence of pulmonary hypertension in schistosomiasis patients with the hepatosplenic form of the disease.

Methods and Results — All patients with hepatosplenic schistosomiasis followed up at the gastroenterology department of our university hospital underwent echocardiographic evaluation to search for pulmonary hypertension. Patients presenting with systolic pulmonary artery pressure >40 mm Hg were further evaluated through right heart catheterization. Our study showed an 18.5% prevalence of patients with elevated systolic pulmonary artery pressure at echocardiography. Invasive hemodynamics confirmed the presence of pulmonary hypertension in 7.7% (95% confidence interval, 3.3 to 16.7) of patients, with a prevalence of precapillary (arterial) pulmonary hypertension of 4.6% (95% confidence interval, 1.5 to 12.7).

Conclusions — Our study reinforces the role of echocardiography as a screening tool in the investigation of pulmonary hypertension, together with the need for invasive monitoring for a proper diagnosis. We conclude that hepatosplenic schistosomiasis may account for one of the most prevalent forms of pulmonary hypertension worldwide, justifying the development of further studies to evaluate the effect of specific pulmonary hypertension treatment in this particular form of the disease.

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