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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_51_библиотеки_им_акад_М_И_Перельмана
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Fatty liver disease 177
Acute liver failure 177
Liver transplantation 178
Bleeding in liver diseases 178
Incidence and pathogenesis 180
Prevention 180
Treatment 182
Thrombosis in liver diseases 184
Incidence and pathogenesis 184
Prevention 185
Treatment 187
Which drugs? 187
Intrahepatic thrombosis and disease progression 188
Hemostasis and liver regeneration 190
Delivery of growth factors 191
Delivery of platelet-derived RNA 192
Platelets as initiators of the inflammatory response 192
Fibrin and liver regeneration 192
Conclusion 192
References 193
14. Peripheral vasculature in portal
hypertension 203
SEONG HEE KANG AND SOON KOO BAIK
Introduction 203
Hyperdynamic circulation 203
Clinical features of hyperdynamic circulation 203
Pathogenesis of hyperdynamic circulation 205
Increased blood and plasma volume/decreased
effective circulating volume 209
Peripheral venous “sump” effect due to venous pooling 209
Abnormalities of arterial vascular tone 209
Vasoactive molecules 209
Inflammation 210
Nervous system and peripheral vascular changes 211
Autonomic dysfunction 211
Cerebral circulation 211
Management of hyperdynamic circulation 212
Conclusions 213
References 213
15. Cirrhotic cardiomyopathy 217
HONGQUN LIU, DALJEET CHAHAL, VLADIMIR MARQUEZ AND
SAMUEL S. LEE
Introduction 217
Definition and diagnostic criteria 217
Distinction from other cardiomyopathies 218
Clinical significance 221
Prevalence 221
Morbidity/mortality after cardiovascular challenges 223
Transjugular intrahepatic portal systemic shunts 223
Cirrhotic cardiomyopathy and prognosis 226
Pathogenic mechanisms 226
TNFα 227
β-Adrenergic signaling 227
Membrane fluidity 227
Bile acids 228
Nitric oxide 228
Carbon monoxide 229
Myosin heavy chain isoform shift 229
The role of ion channels in cirrhotic cardiomyopathy 230
Titin and collagen isoforms 230
Endocannabinoids 230
Summary of mechanisms 231
Management 231
β-Adrenergic receptor blockers (β-blockers) 231
Combination vasoconstrictors and albumin 233
Albumin 238
Antioxidant and antiinflammatory treatments 238
Liver transplantation 238
CCM reversibility: QTc prolongation 240
CCM reversibility: Systolic and diastolic function 240
Conclusion 241
References 241
16. Cardiovascular dysfunction in liver diseases:
pediatric perspectives 247
NOELLE GORGIS AND MORESHWAR S. DESAI
Introduction 247
Cardiovascular consequences of structural congenital
heart diseases coexisting with diseases of the liver 248
Alagille syndrome 248
Biliary atresia splenic malformation syndrome 249
Heart defects associated with Abernathy malformation of
portal vein 249
Implications of coexisting congenital heart diseases for
liver transplantation 249
Cardiovascular complications of pediatric cirrhosis 250
Bile acid-myocardial interaction as a potential mechanism
of cardiomyopathy 255
Heart as a target for bile acids 256
Clinical evidence of pathologic bile acid-myocardial
interaction 256
Historic evidences of pathologic bile acid-myocardial
interaction in animal models 256
Mechanistic insights into bile acid-myocardial interaction 257
Bile acids induce metabolic disturbance in the
heart—the concept of cholecardia 257
Implications for intensive care management and liver
transplantation 258
Cardiovascular consequences of inherited metabolic
liver failure and failure of energy metabolism 258
Hereditary hemochromatosis 259
Neonatal hemochromatosis 259
Glycogen storage diseases 259
Wilson disease 260
Tyrosinemia type 1 260
Primary hyperoxaluria type 1 260
Propionic acidemia 260
Homozygous familial hypercholesterolemia 261
Disorders of inborn error in energy metabolism 261
Cardiovascular consequences of acute liver failure 261
Implications for intensive care management and liver
transplantation 261
x Contents
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Cardiovascular consequences of chronic cirrhosis, portal
hypertension, and portosystemic shunts 262
Hepatopulmonary syndrome 262
Implications of HPS for intensive care management and
liver transplantation 262
Cardiovascular consequences of immunotherapy used in
liver transplants 264
Implications of tacrolimus-induced cardiotoxicty for
intensive care management and liver transplantation 264
Evaluation of the cardiovascular status before liver
transplantation 264
Cardiac biomarkers in plasma/sera 264
Electrocardiography 265
Echocardiography 265
Cardiac catheterization 268
Cardiac MRI 269
Future directions and opportunities for research 269
References 269
17. Hepatorenal syndrome and acute kidney
injury in cirrhosis 275
FLORENCE WONG
Introduction 275
The evolving concept of renal dysfunction in cirrhosis 275
Definition and diagnostic criteria of acute kidney injury in
cirrhosis 277
Epidemiology 278
Pathophysiology 278
Hemodynamic changes in cirrhosis 278
Cardiac dysfunction in cirrhosis 279
The role of inflammation 280
Predictive factors for the development of hepatorenal
syndrome-acute kidney injury 280
Diagnosis 280
Biomarkers 281
Management 282
General measures 282
Albumin 283
Vasoconstrictors 283
Terlipressin 283
Norepinephrine 284
Midodrine and octreotide 285
Predictors of response to vasoconstrictors 285
Renal replacement therapy 285
Liver transplantation 285
Combined liver kidney transplant 286
Prognosis 286
Prevention 287
Conclusion 287
References 288
18. Cardiopulmonary considerations for the
anesthetic management of liver transplantation 293
CHRISTOPHER L. WRAY AND RYAN CHADHA
Perioperative cardiovascular management in the
liver transplant patient 293
Immediate preoperative evaluation, optimization, and
planning 293
Intraoperative management 296
Early postoperative cardiac evaluation and management 300
Perioperative pulmonary management in the liver transplant
recipient 302
Preoperative pulmonary assessment and optimization 302
Intraoperative pulmonary considerations 304
Postoperative pulmonary considerations 304
References 305
19. Cardiovascular assessment before liver
transplantation 309
ILIANA DOYCHEVA, MANHAL IZZY AND KYMBERLY D. WATT
Introduction 309
Assessment of coronary artery disease 309
Assessment of cardiac dysrhythmias 316
Assessment of heart failure 319
References 320
20. Predicting cardiovascular complications
after liver transplantation 327
HARINI GURRAM, JENNIFER JO AND LISA B. VANWAGNER
Introduction 327
Epidemiology and established risk factors for
cardiovascular complications in liver transplantation 327
Natural history and timing of cardiovascular events in liver
transplantation 329
Perioperative complications 329
Postoperative complications 331
Late ( . 90-day period) 335
Identified future areas of study in liver transplantation
complications 337
Algorithms and risk calculators for prediction of
cardiovascular risk after liver transplantation 338
Liver specific risk predictors 338
Nonsurgical general cardiac risk assessment tools 338
Serum biomarkers 340
Surgical cardiac risk calculators 341
Individual predictors of perioperative cardiovascular
disease mortality after liver transplantation 342
Risk models for prediction of perioperative
cardiovascular disease mortality after liver
transplantation 343
Conclusions 345
References 345
Index 349
xiContents
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List of contributors
Juan Gonzalez Abraldes Liver Unit, Division of
Gastroenterology, University of Alberta, Edmonton, AB,
Canada
Mario Altieri Service d’He
´
pato-Gastroente
´
rologie et
Nutrition, Unite
´
de Transplantation He
´
patique, Centre
Hospitalier Universitaire, Caen, France
Vicente Arroyo EF Clif, EASL-CLIF Consortium and
Grifols Chair, Barcelona, Spain
Dina Attia Gastroenterology, Hepatology and Endemic
Diseases Departments, Beni Suef University, Beni Suef, Egypt
Anna Baiges Barcelona Hepatic Hemodynamic Laboratory,
Liver Unit, Hospital Clı
´
nic, Institut de Investigacions
Biome
`
diques August Pi i Sunyer (IDIBAPS), Centro de
Invetsigacio
´
n Biome
´
dica en Red de Enfermedades
Hepa
´
ticas y Digestivas (CIBERehd), Instituto de Salud
Carlos III, Universidad de Barcelona, Health Care
Provider of the European Reference Network on Rare
Liver Disorders (ERN-Liver), Madrid, Spain
Soon Koo Baik Department of Internal Medicine, Wonju
Severance Christian Hospital, Yonsei University Wonju
College of Medicine, Wonju, Korea; Regeneration
Medicine Research Center, Yonsei University Wonju
College of Medicine, Wonju, Korea; Cell Therapy and
Tissue Engineering Center, Yonsei University Wonju
College of Medicine, Wonju, Korea
Fabian Betancourt Barcelona Hepatic Hemodynamic
Laboratory, Liver Unit, Hospital Clı
´
nic, Institut de
Investigacions Biome
`
diques August Pi i Sunyer
(IDIBAPS), Centro de Invetsigacio
´
n Biome
´
dica en Red de
Enfermedades Hepa
´
ticas y Digestivas (CIBERehd),
Instituto de Salud Carlos III, Universidad de Barcelona,
Health Care Provider of the European Reference Network
on Rare Liver Disorders (ERN-Liver), Madrid, Spain
Ryan Chadha Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic, Jacksonville, FL,
United States
Daljeet Chahal University of British Columbia, Vancouver,
BC, Canada
Po-Hung Chen Division of Gastroenterology &
Hepatology, Department of Medicine, Johns Hopkins
University School of Medicine, Baltimore, MD, United
States
Moreshwar S. Desai Pediatric Liver Intensive Care,
Department of Pediatrics, Division of Pediatric Critical
Care, Texas Children’s Hospital and Baylor College of
Medicine, Houston, TX, United States
Iliana Doycheva Division of Gastroenterology &
Hepatology, The Mayo Clinic, Rochester, MN, United
States
Javier Fernandez EF Clif, EASL-CLIF Consortium and
Grifols Chair, Barcelona, Spain; Liver Unit, Hospital
Clı
´
nic, IDIBAPS and CIBERehd, Barcelona, Spain
Yasser Fouad Gastroenterology, Hepatology and Endemic
Diseases Departments, Minia University, Minia, Egypt
Juan Carlos Garcı
´
a-Paga
´
n Barcelona Hepatic
Hemodynamic Laboratory, Liver Unit, Hospital Clı
´
nic,
Institut de Investigacions Biome
`
diques August Pi i Sunyer
(IDIBAPS), Centro de Invetsigacio
´
n Biome
´
dica en Red de
Enfermedades Hepa
´
ticas y Digestivas (CIBERehd),
Instituto de Salud Carlos III, Universidad de Barcelona,
Health Care Provider of the European Reference Network
on Rare Liver Disorders (ERN-Liver), Madrid, Spain
Noelle Gorgis Pediatric Liver Intensive Care, Department
of Pediatrics, Division of Pediatric Critical Care, Texas
Children’s Hospital and Baylor College of Medicine,
Houston, TX, United States
Harini Gurram Department of Medicine, Division of
Gastroenterology and Hepatology, Northwestern
University Feinberg School of Medicine, Chicago, IL,
United States
Virginia Herna
´
ndez-Gea Barcelona Hepatic Hemodynamic
Laboratory, Liver Unit, Hospital Clı
´
nic, Institut de
Investigacions Biome
`
diques August Pi i Sunyer
(IDIBAPS), Centro de Invetsigacio
´
n Biome
´
dica en Red de
Enfermedades Hepa
´
ticas y Digestivas (CIBERehd),
Instituto de Salud Carlos III, Universidad de Barcelona,
Health Care Provider of the European Reference
Network on Rare Liver Disorders (ERN-Liver), Madrid,
Spain
Shaz Iqbal Division of Gastroenterology & Hepatology,
Department of Medicine, Johns Hopkins University
School of Medicine, Baltimore, MD, United States
Manhal Izzy Division of Gastroenterology, Hepatology,
and Nutritions, Vanderbilt University, Nashville, TN,
United States
Jennifer Jo Department of Medicine, Division of
Gastroenterology and Hepatology, Northwestern
University Feinberg School of Medicine, Chicago, IL,
United States
Seong Hee Kang Department of Internal Medicine, Wonju
Severance Christian Hospital, Yonsei University Wonju
College of Medicine, Wonju, Korea; Regeneration
Medicine Research Center, Yonsei University Wonju
College of Medicine, Wonju, Korea; Cell Therapy and
Tissue Engineering Center, Yonsei University Wonju
College of Medicine, Wonju, Korea; Department of
Internal Medicine, Inje University College of Medicine,
Seoul, Korea
xiii
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Rofida Khalifa Gastroenterology, Hepatology and Endemic
Diseases Departments, Minia University, Minia, Egypt
Masahiro Koseki Division of Cardiovascular Medicine,
Department of Medicine, Osaka University Graduate
School of Medicine, Suita, Osaka, Japan
Masanari Kuwabara Department of Cardiology,
Toranomon Hospital, Minato, Tokyo, Japan; Department
of Cardiology, Cardiovascular Center, St. Luke’s
International Hospital, Chuo, Tokyo, Japan
Samuel S. Lee Liver Unit, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
Ton Lisman Surgical Research Laboratory, Section of
Hepatobiliary Surgery and Liver Transplantation,
Department of Surgery, University Medical Center
Groningen, University of Groningen, Groningen, The
Netherlands
Hongqun Liu Liver Unit, Cumming School of Medicine,
University of Calgary, Calgary, AB, Canada
Xuefeng Luo Barcelona Hepatic Hemodynamic Laboratory,
Liver Unit, Hospital Clı
´
nic, Institut de Investigacions
Biome
`
diques August Pi i Sunyer (IDIBAPS), Centro de
Invetsigacio
´
n Biome
´
dica en Red de Enfermedades
Hepa
´
ticas y Digestivas (CIBERehd), Instituto de Salud
Carlos III, Universidad de Barcelona, Health Care
Provider of the European Reference Network on Rare
Liver Disorders (ERN-Liver), Madrid, Spain
Marta Magaz Barcelona Hepatic Hemodynamic
Laboratory, Liver Unit, Hospital Clı
´
nic, Institut de
Investigacions Biome
`
diques August Pi i Sunyer
(IDIBAPS), Centro de Invetsigacio
´
n Biome
´
dica en Red de
Enfermedades Hepa
´
ticas y Digestivas (CIBERehd),
Instituto de Salud Carlos III, Universidad de Barcelona,
Health Care Provider of the European Reference Network
on Rare Liver Disorders (ERN-Liver), Madrid, Spain
Vladimir Marquez University of British Columbia,
Vancouver, BC, Canada
Richard Moreau EF Clif, EASL-CLIF Consortium and
Grifols Chair, Barcelona, Spain; INSERM et Universite
´
de
Paris, Centre de Recherche sur l’Inflammation (CRI),
Paris, France; Service d’He
´
patologie, Ho
ˆ
pital Beaujon, AP-
HP, Clichy, France
Oana Nicoara
˘
-Farca
˘
u Barcelona Hepatic Hemodynamic
Laboratory, Liver Unit, Hospital Clı
´
nic, Institut de
Investigacions Biome
`
diques August Pi i Sunyer
(IDIBAPS), Centro de Invetsigacio
´
n Biome
´
dica en Red de
Enfermedades Hepa
´
ticas y Digestivas (CIBERehd),
Instituto de Salud Carlos III, Universidad de Barcelona,
Health Care Provider of the European Reference Network
on Rare Liver Disorders (ERN-Liver), Madrid, Spain
Koichiro Niwa Department of Cardiology, Cardiovascular
Center, St. Luke’s International Hospital, Chuo, Tokyo, Japan
Atsushi Okada Department of Cardiovascular Medicine,
National Cerebral and Cardiovascular Center, Suita,
Osaka, Japan
P. Timothy Pollak Department of Medicine and Cardiac
Sciences, Amiodarone Monitoring Clinic, University of
Calgary, Calgary, AB, Canada
Yuki Saito Department of Cardiology, Nihon University
School of Medicine, Itabashi, Tokyo, Japan
Bonifasius S. Singu School of Pharmacy, Faculty of Health
Sciences and Veterinary Medicine, University of Namibia,
Windhoek, Namibia
Guillem Soy Barcelona Hepatic Hemodynamic Laboratory,
Liver Unit, Hospital Clı
´
nic, Institut de Investigacions
Biome
`
diques August Pi i Sunyer (IDIBAPS), Centro de
Invetsigacio
´
n Biome
´
dica en Red de Enfermedades
Hepa
´
ticas y Digestivas (CIBERehd), Instituto de Salud
Carlos III, Universidad de Barcelona, Health Care
Provider of the European Reference Network on Rare
Liver Disorders (ERN-Liver), Madrid, Spain
Tatsunori Taniguchi Department of Cardiovascular
Medicine, Osaka University Graduate School of Medicine,
Suita, Osaka, Japan
Fanny Turon Barcelona Hepatic Hemodynamic Laboratory,
Liver Unit, Hospital Clı
´
nic, Institut de Investigacions
Biome
`
diques August Pi i Sunyer (IDIBAPS), Centro de
Invetsigacio
´
n Biome
´
dica en Red de Enfermedades
Hepa
´
ticas y Digestivas (CIBERehd), Instituto de Salud
Carlos III, Universidad de Barcelona, Health Care
Provider of the European Reference Network on Rare
Liver Disorders (ERN-Liver), Madrid, Spain
Paradis Vale
´
rie Pathology Department, Beaujon Hospital,
Paris University, Paris, France
Lisa B. VanWagner Department of Medicine, Division of
Gastroenterology and Hepatology, Northwestern
University Feinberg School of Medicine, Chicago, IL,
United States; Department of Preventive Medicine,
Division of Epidemiology, Northwestern University
Feinberg School of Medicine, Chicago, IL, United States
Roger K. Verbeeck School of Pharmacy, Faculty of Health
Sciences and Veterinary Medicine, University of Namibia,
Windhoek, Namibia
Kymberly D. Watt Division of Gastroenterology &
Hepatology, The Mayo Clinic, Rochester, MN, United States
Florence Wong Division of Gastroenterology and
Hepatology, Department of Medicine, University of
Toronto, Toronto General Hospital, Toronto, ON, Canada
Christopher L. Wray Department of Anesthesiology,
University of California Los Angeles, Los Angeles, CA,
United States
xiv List of contributors
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Preface
We are pleased to introduce the first book devoted to the relationship between the heart and liver. This field,
called “cardio-hepatology” has been the subject of study over the past century. However, interest in the heart/
liver relationship actually dates back several thousand years. This history is detailed in Chapter 1.
The book is then divided into three major sections. Part I has five chapters devoted to various aspects of the
heartliver interaction. Part II comprises six chapters on the theme of the hepatobiliary system in heart failure.
Finally, the theme of Part III is the converse: the cardiovascular system in liver failure, with nine chapters.
Befitting the theme of this book, the editors are a cardiologist (TT) and hepatologist (SSL).
This is a truly international project with authors from several countries spanning the globe. They are all well-
published authorities in their fields and were encouraged to write exhaustive and definitive monographs with
extensive figures and illustrations.
Producing any book, especially a large complex one such as this with several specialized subtopics, in the age
of Covid-19 was a daunting and difficult chall enge. However, thanks to the hard work and efficiency of the
authors and the Elsevier Production staff, including the project managers Megan Ashdown and Franchezca
Cabural, the project finally came to fruition.
We hope that clinicians and researchers in cardiology, hepatology, surgery, anesthesiology, pediatrics, inten-
sive care medicine, histopathology, and translational medicine will find this book useful and informative.
Samuel S. Lee
Tatsunori Taniguchi
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PART 1
Liver and heart
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CHAPTER
1
The liverheart relationship: a history
Hongqun Liu and Samuel S. Lee
Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
Introduction
The heartliver history dates back at least 5000 years and can be conveniently divided into three time periods:
the ancient, medieval, and modern. This chapter will review events in all of these three periods. The liver held
sway as perhaps the dominant organ in the body until the middle ages when the seminal work by William
Harvey the English physiologist established that blood circulation is a unified entity pumped by the heart and
the liver does not play a role. About two centuries later, another European physician, Rene
´
La
¨
ennec, contributed
two key things that would revolutionize both cardiothoracic medicine and hepatology: the stethoscope and the
word “cirrhosis.” Amazingly, both items appeared in the same landmark publication in 1819.
The liverheart relationship then entered the 20th century when two important events took place. The first,
starting early in the century, was the description of cardiac hepatopathy, called “foie cardiaque” in French. This
refers to the condition of the liver when the heart fails. The second, the conceptual converse of the foie cardiaque,
comprised two subtopics, the hyperdynamic circulation of cirrhosis from the 1950s and cirrhotic cardiomyopathy,
a concept born in the late 1980s.
The ancient world: east and west
The first major publication devoted to the study of medicine is generally accepted to be the “Yellow
Emperor’s Classic of Medicine” (Huang di Neijing), which states back about 5000 years. Indeed, this text under-
lies the basis of traditional Chinese medicine (TCM). The relationship between the liver and heart is described as
a part of the human corporeal and environmental natural harmony. We discuss these in the present tense because
even though the concepts were generated so long ago, TCM practitioners still use these concepts.
The four seasons, the five organs, and the Yin and Yang theory are the core content of the medical theory sys-
tem in the Yellow Emperor’s book. This theory focuses on the functional connection and dynamic balance, the
integrity of the human body, the mutual coordination, and the control of the five organs. These five organs are
liver, heart, lung, kidney, and spleen. Disrupting these dynamic balances results in diseases.
First of all, many concepts of the liver and heart, like other organs, are not based purely on anatomy. These
concepts are the combination of the seasons, the Yin and Yang, and the spirits and body. The liver represents
spring, heart represents summer, lung represents autumn, and kidney represents winter. These organs are also
correlated with natur al phenomena: the liver represents wood, heart represents fire, lung represents gold, sple en
represents soil, and kidney represents water.
There are mutual generations and restrictions. The generation theory is that liver generates heart, heart gener-
ates spleen, spleen generates lungs, lungs generate kidneys, and kidneys generate liver. These compose a genera-
tive circle. The restriction theory is that liver restricts spleen, spleen restricts kidneys, kidneys res trict heart, heart
restricts lungs, and lungs restrict liver. These constitute a restrictive circle.
3
Cardio-Hepatology.
DOI:
https://doi.org/10.1016/B978-0-12-817394-7.00020-6 © 2023 Elsevier Inc. All rights reserved.
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