Massive pulmonary and intracardiac embolism during liver transplantation.
Despite prolonged coagulation times and thrombocytopenia associated with end-stage liver disease, formation of thrombi in the circulation seems to occur more frequently during liver transplant than during any other type of major surgery. Here, we report a case of massive pulmonary and intracardiac embolism that resulted in cardiac arrest and intraoperative death. This was diagnosed by transesophageal echocardiography and occurred shortly after induction of anesthesia and initiation of continuous veno-venous hemofiltration without the concomitant use of antifibrinolytic drugs. We discuss the physiologic changes associated with cirrhosis and liver transplant, and review the literature.
Martins
Paulo N
PN
Kim-Schluger
Leona
L
Rodriguez-Davalos
Manuel
M
Martins
Ann-Britt
AB
Krachkova
Nathalia
N
Facciuto
Marcelo
M
Sheiner
Patricia
P
D000368:Aged; D001777:Blood Coagulation; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006331:Heart Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*