Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantation.
Severe pulmonary thromboembolism has been occasionally reported during orthotopic liver transplantation, with fatal outcomes occurring in about 50% of cases because of low cardiac output and multiple organ failure. Perioperative alterations in coagulation, insertion of pulmonary artery and other invasive catheters, administration of antifibrinolytic agents, and repeated ischemic insults may all promote the formation of intravascular/cardiac blood clots. We present a case of intraoperative right ventricular failure associated with the presence of a large thrombus wrapped around the pulmonary artery catheter. Identification of risk factors for intraoperative pulmonary thromboembolism warrants a prophylactic medical approach including selective blood component therapy and administration of antifibrinolytics guided by bedside coagulation tests as well as noninvasive hemodynamic monitoring.
Ellenberger
Christoph
C
Division of Anesthesiology, University Hospital, CH-1211 Geneva, Switzerland.
Mentha
Gilles
G
Giostra
Emiliano
E
Licker
Marc
M
D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects; D001794:Blood Pressure; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D020105:Milrinone / Q000008:administration & dosage; D009569:Nitric Oxide / Q000008:administration & dosage; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D017713:Platelet Transfusion / Q000009:adverse effects; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000077585:Terlipressin; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D001993:Bronchodilator Agents; D002316:Cardiotonic Agents; D006490:Hemostatics; D010975:Platelet Aggregation Inhibitors; D009569:Nitric Oxide; D008236:Lypressin; D000077585:Terlipressin; D007611:Aprotinin; D020105:Milrinone