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Post-Splenectomy Pulmonary Hypertension: Characteristics of 49 Patients

Jason Golbin

Michael McGoon

Michael Krowka


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Conference: 2008 International PHA Conference and Scientific Sessions

Release Date: 06.20.2008

Presentation Type: Abstracts

Golbin J.M., McGoon M.D., Krowka M.J.

Mayo Clinic College of Medicine, Rochester, MN, USA

BACKGROUNDThe spleen is a hematopoietic organ with a myriad of functions, including immunological participation, removal of senescent cells and particulates from the blood, platelet sequestration, and under abnormal conditions, extramedullary hematopoiesis.  Splenectomy is often performed for diagnosis or treatment of a variety of hematologic disorders.  A relationship between splenectomy and pulmonary hypertension (PH) has been previously suggested in the literature.  We sought to further explore the clinical implications of this relationship.

METHODSRetrospective computer-aided retrieval of Mayo Clinic Rochester records between 1976 and 2005 identified 7163 patients with splenectomy.  PH was coded in 98.  Of these, PH was definitively diagnosed subsequent to splenectomy in 49; a separate cohort of 33 patients had PH documented prior to splenectomy.  Charts with available electronic records were abstracted for pertinent information including:

Time between splenectomy and PH diagnosis, mortality, reason for splenectomy, etiology of splenomegaly, method of PH diagnosis, concomitant pulmonary diagnosis, concomitant cardiac diagnosis, concomitant sleep diagnosis, and pulmonary function abnormalities

RESULTSThe post-splenectomy cohort (n=49) had a mean age=53 (+/-19).  25 were female.  26 patients are alive and 22 have died.  Splenectomy was performed at Mayo in 39.  The most common indications for splenectomy were: in association with another surgery (n=11), splenomegaly (17) (itself due to hematologic disorders in 15/17), idiopathic thrombocytopenia (7), and malignancy affecting the spleen (7).  PH was diagnosed by echocardiography (40), both echo and right heart catheterization (RHC) (8), and pulmonary angiogram (1).  Median right ventricular systolic pressure by echo was 59 mmHg (intra-quartile range 46-72).  By RHC, median mPAP=44 mmHg (34-55) and median PAOP=16 mmHg (14-18).  The median number of days between splenectomy and diagnosis of PH was 2523 (IQR 589-5729).  Concomitant pulmonary diagnoses were found in 23, most commonly non-specific pulmonary function (PFT) changes (7), followed by mild obstruction (3), severe restriction (3), and pulmonary embolism (4).  The median PFT diffusing capacity was 63% of expected (IQR 51-73%).  Concomitant cardiac diagnoses were found in 28, most commonly coronary artery disease (15).  Concomitant sleep disorder was found in 14, most commonly undefined with an abnormal overnight oximetry (8).

CONCLUSIONTo our knowledge, this represents the largest cohort of patients having splenectomy in which subsequent PH was documented.  The relationship between splenectomy and various etiologies for PH should be clarified by additional prospective studies.