Korean J Anesthesiol.  2010 Dec;59(Suppl):S128-S132. 10.4097/kjae.2010.59.S.S128.

Dynamic left ventricular outflow tract obstruction in living donor liver transplantation recipients: A report of two cases

• Lee AR
• Kim YR
• Ham JS
• Lee SM
• Kim GS

• KMID: 2237370
• DOI: http://doi.org/10.4097/kjae.2010.59.S.S128

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.

Keyword

Dynamic left ventricular outflow tract obstruction; Intraoperative transesophageal echocardiography; Living donor liver transplantation

MeSH Terms

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