Diagnosis and treatment of intracardiac thrombosis during orthotopic liver transplantation.
Intracardiac thrombus formation during orthotopic liver transplantation can be a catastrophic event leading to death. Most often this devastating complication occurs after reperfusion and may be related to massive blood transfusion, marginal liver grafts, tendencies towards hypercoagulability, or the potential role of antifibrinolytics. We report a case of an intracardiac thrombus occurring during the hepatectomy stage (stage I) of orthotopic liver transplantation. Transesophageal echocardiography was used to quickly diagnose the thrombus, allowing rapid pharmacological intervention and later guide surgical evacuation of the intracardiac thrombus via the inferior vena cava.
Director of Hepatic Transplantation Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Room C-207, Pittsburgh, PA 15213, USA. planinsicrm@anes.upmc.edu
Raymond M
RM
Planinsic
Ramona
R
Nicolau-Raducu
Bijan
B
Eghtesad
Amadeo
A
Marcos
D058186:Acute Kidney Injury / Q000150:complications; D001780:Blood Coagulation Tests; D003128:Coma / Q000150:complications; D003328:Coronary Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D017548:Echocardiography, Transesophageal; D005260:Female; D006400:Hematocrit; D006498:Hepatectomy; D019693:Hepatitis, Autoimmune / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D016031:Liver Transplantation / Q000502:physiology*; D008875:Middle Aged; D013916:Thrombelastography