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Splenectomy-Induced Portal Hypertension and Pulmonary Hypertension
- Marius M. Hoeper, MD; and
- Jost Niedermeyer, MD
- Hannover Medical School; 30623 Hannover, Germany (Hoeper) Hannover Medical School; 30623 Hannover, Germany (Niedermeyer)
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IN RESPONSE:
We thank Teramoto and colleagues for their comments. Their suggestions about possible mechanisms for the development of pulmonary hypertension after splenectomy are inconclusive. First, the development of portal hypertension after splenectomy is rare, and coexistence of portal hypertension and pulmonary hypertension was thoroughly excluded by Doppler ultrasonography in all our patients. No evidence suggests that abnormal pulmonary vasodilatation as part of the hepatopulmonary syndrome plays any role in splenectomy-associated pulmonary hypertension. Hypoxic vasoconstriction is not a feature of the hepatopulmonary syndrome, and respiratory acidosis is almost never involved.
Teramoto and colleagues also stressed the role of impaired regional NO synthetase expression for the development of the hepatopulmonary syndrome and pulmonary hypertension. Although increased levels of exhaled NO have been demonstrated with intrapulmonary vascular dilatation (1, 2), the situation is less clear for pulmonary hypertension (3, 4). However, the conclusion that splenectomy does not always cause pulmonary hypertension because hypoxia inhibits NO production (and therefore abnormal pulmonary vasodilation) is not supported by scientific evidence and contradicts clinical experience. Most patients who have had splenectomy are normoxic and will probably never develop pulmonary vascular disease. According to our experience and from the correspondence we received after our paper was published, the risk for pulmonary hypertension after splenectomy seems especially high in patients with hemolytic disorders, such as spherocytosis or thalassemia. Therefore, we think it is reasonable to assume that the prolonged presence of abnormal erythrocytes in the circulation is involved in the pathogenesis of postsplenectomy pulmonary hypertension. The exact mechanism, however, remains speculative.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
