Dynamic left ventricular outflow tract obstruction in living donor liver transplantation recipients: A report of two cases.
10.4097/kjae.2010.59.S.S128
- Author:
Ae Ryoung LEE
1
;
Young Ri KIM
;
Ji Sun HAM
;
Sangmin Maria LEE
;
Gaab Soo KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Seoul, Korea. gskim@skku.edu
- Publication Type:Case Report
- Keywords:
Dynamic left ventricular outflow tract obstruction;
Intraoperative transesophageal echocardiography;
Living donor liver transplantation
- MeSH:
Echocardiography;
Echocardiography, Transesophageal;
Hemodynamics;
Humans;
Hypertrophy, Left Ventricular;
Liver;
Liver Transplantation;
Living Donors;
Mitral Valve;
Reperfusion;
Resuscitation;
Ventricular Function
- From:Korean Journal of Anesthesiology
2010;59(Suppl):S128-S132
- CountryRepublic of Korea
- Language:English
-
Abstract:
We present two cases of dynamic left ventricular outflow tract obstruction in 2 patients who were undergoing living donor liver transplantation. On the preoperative transthoracic echocardiography, the first patient showed normal ventricular function and a normal wall thickness, but severe hemodynamic deterioration developed during the anhepatic period and this was further aggravated after reperfusion in spite of volume resuscitation and catecholamine therapy. Intraoperative transesophageal echocardiography revealed the systolic anterior motion of the mitral valve leaflet together with left ventricular outflow tract obstruction. The second patient showed left ventricular hypertrophy with left ventricular outflow tract obstruction on the preoperative echocardiography. Intraoperative transesophageal echocardiography was used to guide fluid administration and the hemodynamic management throughout the procedure and a temporary portocaval shunt was established to mitigate the venous pooling during the anhepatic period. The purpose of this report is to emphasize the clinical significance of dynamic left ventricular outflow tract obstruction in patients who are undergoing living donor liver transplantation and the role of intraoperative echocardiography to detect and manage it.
