Skeletal Class II malocclusion often leads to excessive overjet due to differences in arch growth, and in some cases, an unstable contact point of the mandibular incisors can result in deep bite. When the relationship of anterior teeth is unstable, the extruded height of the mandibular incisors must be adjusted, followed by restoration of the maxillary incisors. During this process, an interim restoration period is necessary to evaluate aesthetics, phonetics, and function of the anterior teeth, and if extractions and implants are involved, the restoration steps may increase. In this case, facial scan was utilized to obtain extraoral data for stepwise fabrication of provisional restorations, ultimately transitioning them into final restorations. This approach aimed to improve both function and aesthetics for the patient, who required multiple implants and fixed prostheses on natural teeth, including in the anterior region.

Skeletal Class II malocclusion often leads to excessive overjet due to differences in arch growth, and in some cases, an unstable contact point of the mandibular incisors can result in deep bite. When the relationship of anterior teeth is unstable, the extruded height of the mandibular incisors must be adjusted, followed by restoration of the maxillary incisors. During this process, an interim restoration period is necessary to evaluate aesthetics, phonetics, and function of the anterior teeth, and if extractions and implants are involved, the restoration steps may increase. In this case, facial scan was utilized to obtain extraoral data for stepwise fabrication of provisional restorations, ultimately transitioning them into final restorations. This approach aimed to improve both function and aesthetics for the patient, who required multiple implants and fixed prostheses on natural teeth, including in the anterior region.

Skeletal Class II malocclusion often leads to excessive overjet due to differences in arch growth, and in some cases, an unstable contact point of the mandibular incisors can result in deep bite. When the relationship of anterior teeth is unstable, the extruded height of the mandibular incisors must be adjusted, followed by restoration of the maxillary incisors. During this process, an interim restoration period is necessary to evaluate aesthetics, phonetics, and function of the anterior teeth, and if extractions and implants are involved, the restoration steps may increase. In this case, facial scan was utilized to obtain extraoral data for stepwise fabrication of provisional restorations, ultimately transitioning them into final restorations. This approach aimed to improve both function and aesthetics for the patient, who required multiple implants and fixed prostheses on natural teeth, including in the anterior region.

Skeletal Class II malocclusion often leads to excessive overjet due to differences in arch growth, and in some cases, an unstable contact point of the mandibular incisors can result in deep bite. When the relationship of anterior teeth is unstable, the extruded height of the mandibular incisors must be adjusted, followed by restoration of the maxillary incisors. During this process, an interim restoration period is necessary to evaluate aesthetics, phonetics, and function of the anterior teeth, and if extractions and implants are involved, the restoration steps may increase. In this case, facial scan was utilized to obtain extraoral data for stepwise fabrication of provisional restorations, ultimately transitioning them into final restorations. This approach aimed to improve both function and aesthetics for the patient, who required multiple implants and fixed prostheses on natural teeth, including in the anterior region.

Skeletal Class II malocclusion often leads to excessive overjet due to differences in arch growth, and in some cases, an unstable contact point of the mandibular incisors can result in deep bite. When the relationship of anterior teeth is unstable, the extruded height of the mandibular incisors must be adjusted, followed by restoration of the maxillary incisors. During this process, an interim restoration period is necessary to evaluate aesthetics, phonetics, and function of the anterior teeth, and if extractions and implants are involved, the restoration steps may increase. In this case, facial scan was utilized to obtain extraoral data for stepwise fabrication of provisional restorations, ultimately transitioning them into final restorations. This approach aimed to improve both function and aesthetics for the patient, who required multiple implants and fixed prostheses on natural teeth, including in the anterior region.

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.
Echocardiography ; Echocardiography, Transesophageal ; Hemodynamics ; Humans ; Hypertrophy, Left Ventricular ; Liver ; Liver Transplantation ; Living Donors ; Mitral Valve ; Reperfusion ; Resuscitation ; Ventricular Function