title: Ductular cholestasis, an unusual form of intrahepatic cholestasis, associated with cardiogenic shock and ventricular assist device.
abstract: Ventricular assist devices have been shown to be effective in advanced heart failure selected patients. They often have borderline end-organ function, what facilitates organ dysfunction. Liver failure is difficult to manage and leads to increased morbidity and mortality. We report a case of ductular cholestasis, an unusual cholestatic hepatic failure with untractable coagulopathy, developed during the use of a magnetic levitation centrifugal pump, implanted as a bridge to heart transplantation, in a patient with cardiogenic shock (as an end-stage disease of idiopathic dilated cardiomyopathy). We discussed the pathophysiology of this entity and the possible related factors, including the assist device. Preemptive interventions have been advocated as the primary way of treatment. Preoperative optimization of heart function and avoidance of visceral hypoperfusion and sepsis may play a major role.
authors.affiliation: Cardiovascular Intensive and Postoperative Care Unit (Intensive Care Unit), University Hospital 12 de Octubre, Madrid, Spain. albertomohedanomd@yahoo.es
authors.forename: Alberto
authors.initials: A
authors.lastname: Mohedano-Gómez
authors.forename: José L
authors.initials: JL
authors.lastname: Pérez-Vela
authors.forename: Emilio
authors.initials: E
authors.lastname: Renes-Carreño
authors.forename: Carolina Ibarrola
authors.initials: CI
authors.lastname: De-Andrés
authors.forename: María A
authors.initials: MA
authors.lastname: Corres-Peiretti
authors.forename: Primitivo
authors.initials: P
authors.lastname: Arribas-López
authors.forename: Julián
authors.initials: J
authors.lastname: Gutierrez-Rodriguez
authors.forename: Narciso
authors.initials: N
authors.lastname: Perales-Rodríguez-De-Viguri
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002780:Cholestasis, Intrahepatic / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D006333:Heart Failure / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006353:Heart-Assist Devices; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D012770:Shock, Cardiogenic / Q000150:complications / Q000473:pathology / Q000601:surgery*