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Methods: This double-blind, randomized, placebo-controlled trial was conducted from 2022 to 2024 and included forty-five patients aged 18-70 years with HPS (diagnosed by chronic liver disease with portal hypertension, arterial hypoxemia (PaO2 15 mm Hg), and evidence of intrapulmonary vascular dilatations (IPVDs) demonstrated by contrast-enhanced echocardiography or lung perfusion scans), randomized in a double-blind manner to 2:1 into two arms using the IVR system: Simvastatin 40mg and placebo