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on March 9, 2009

Circulation. 2009
Published online before print March 9, 2009, doi: 10.1161/CIRCULATIONAHA.108.803221
A more recent version of this article appeared on March 24, 2009
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Submitted on July 1, 2008
Accepted on December 9, 2008

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, and 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.

* To whom correspondence should be addressed. E-mail: rogerio.souza{at}incor.usp.br.

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.


Key words: echocardiography • hemodynamics • hypertension, pulmonary • schistosomiasis


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Clinical Summaries
Circulation 2009 119: 1457-1458. [Extract] [Full Text]



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