Successful intraoperative use of recombinant tissue plasminogen activator during liver transplantation complicated by massive intracardiac/pulmonary thrombosis.
During orthotopic liver transplantation a patient received epsilon-aminocaproic acid and clotting factors. Shortly after hepatic artery clamping the patient developed a massive intracardiac/intravascular thrombosis that resulted in cardiac arrest. After diagnosis by transesophageal echocardiography, the patient was treated with recombinant tissue plasminogen activator through a central venous catheter advanced into the right atrium. After treatment with recombinant tissue plasminogen activator, the patient's hemodynamic status improved, permitting the liver transplant to be completed. The patient was ultimately discharged to home. We report the successful intraoperative resuscitation of a patient with acute intracardiac/intravascular thrombosis during an orthotopic liver transplantation using thrombolytic therapy.
Department of Anesthesiology, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07101, USA. jacksod1@umdnj.edu
Douglas
D
Jackson
Andrei
A
Botea
Yuriy
Y
Gubenko
Ellise
E
Delphin
Henry
H
Bennett
D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000188:drug therapy; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014463:Ultrasonography
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator