ABC | Volume 113, Nº5, November 2019

Short Editorial Falcão cTEE in pulmonary intravascular dilation in HSS Arq Bras Cardiol. 2019; 113(5):923-924 1. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB, ERS Task Force Pulmonary-Hepatic Vascular Disorders (PHD) Scientific Committee. Pulmonary-hepaticvasculardisorders(PHD).EurRespirJ.2004;24(5):861-80. 2. Herve P, Le Pavec J, Sztrymf B, Decante B, Savale L, Sitbon O. Pulmonary vascular abnormalities in cirrhosis. Best Pract Res Clin Gastroenterol. 2007;21(1):141-59. 3. SchenkP,FuhrmannV,MadlC,FunkG,LehrS,KandelO,etal.Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut. 2002;51(6):853-9. 4. KimBJ, Lee SC, Park SW, Choi MS, Koh KC, Paik SW, et al. Characteristics and prevalence of intrapulmonary shunt detected by contrast echocardiography with harmonic imaging in liver transplant candidates. Am J Cardiol. 2004;94(4):525-8. 5. Vedrinne JM, Duperret S, Bizollon T, Magnin C, Motin J, Trepo C, et al. Comparison of transesophageal and transthoracic contrast echocardiography for detection of an intrapulmonary shunt in liver disease. Chest. 1997;111(5):1236-40. 6. Fischer CH, Campos O, Fernandes WB, Kondo M, Souza FL, De Andrade JL, et al. Role of contrast-enhanced transesophageal echocardiography for detection of and scoring intrapulmonary vascular dilatation. Echocardiography. 2010;27(10):1233-7. 7. KrowkaMJ, Tajik AJ, Dickson ER, Wiesner RH, Cortese DA. Intrapulmonary vascular dilatations (IPVD) in liver transplant candidates. Screening by two-dimensional contrast-enhanced echocardiography. Chest. 1990;97(5):1165-70. 8. KrowkaMJ, Cortese DA. Hepatopulmonary syndrome. Current concepts in diagnostic and therapeutic considerations. Chest. 1994;105(5):1528-37. 9. De BK, Sen S, Sanyal R. Hepatopulmonary syndrome in noncirrhotic portal hypertension. Ann Intern Med. 2000;132(11):924. 10. Coutinho AD, Domingues ALC. Esquistossomose mansoni. In: Danir R, Castro LP. Gastroenterologia clínica. 3. ed. Rio de Janeiro: Guanabara Koogan; 1993. p. 1697-1728. 11. Lima B, Martinelli A, França AV. Hepatopulmonary syndrome: pathogenesis, diagnosis and treatment. Arq Gastroenterol. 2004;41(4):250-8. 12. Ferreira Rde C, Domingues AL, Markman Filho B, Veras FH, Batista LJ, Albuquerque Filho ES. Hepatopulmonary syndrome in patients with Schistosoma mansoni periportal fibrosis. Acta Trop. 2009;111(2):119-24. 13. Gouvea A, Fischer CH, Anakaki JS, Mancuso FJ, Brant P, Moisés VA, et al. Valor da ecocardiografia transesogagica com contraste no diagnóstico da dilatação vascular intrapulmonar na esquistossomose hepatoespl nica. Arq Bras Cardiol. 2019; 113(5):915-922. References This is an open-access article distributed under the terms of the Creative Commons Attribution License A major challenge in performing a transesophageal examination in these patients is the presence of esophageal varices due to the potential risk of bleeding. It should be noted that in the study mentioned in this issue, 13 all patients underwent digestive endoscopy, and, in the presence of esophageal varices, they were treated with sclerotherapy before the transesophageal examination. Despite the safety of the cTEE described by the authors, care should be taken to evaluate the presence or absence of esophageal varices and the need for sclerosis therapy to minimize the risk of bleeding. The increase in the diagnosis of IPVD through cTEE brings up a group of patients with pulmonary vascular alterations diagnosed by echocardiography; however, with preserved arterial oxygenation profile, which may reflect a preclinical phase of the disease. This aspect, observed in the patients of this study with hepatosplenic schistosomiasis (HSS), has also been described in other studies with cirrhotic and non‑cirrhotic patients. 1 The prognostic role of this finding and its consequence in the natural course of the disease is unknown, requiring further observations. Given the importance of schistosomiasis in our country and the lack of publications regarding the diagnostic analysis of HPS in patients with HSS, studies in this field should be appreciated for their pioneering characteristics and for contributing to a better understanding of this pathology. 924