title: Atrial laceration caused by removal of a transjugular intrahepatic portosystemic shunt necessitates emergent cardiopulmonary bypass during liver transplant: a case report.
abstract: In situ transjugular intrahepatic portosystemic shunting (TIPS) can complicate liver transplantation. We present a case where an intraoperative attempt to remove a malpositioned TIPS resulted in atrial laceration. Massive transfusion and emergent institution of cardiopulmonary bypass allowed patient resuscitation and completion of surgery. We describe our surgical and anesthesiologic management, and discuss the absence of criteria to predict when TIPS may become adherent to the inferior vena cava or the right atrium and difficult to remove.
authors.affiliation: Department of Anesthesiology, Washington University in St. Louis - School of Medicine, St. Louis, MO 63110, USA.
authors.forename: D
authors.initials: D
authors.lastname: Tivener
authors.forename: A
authors.initials: A
authors.lastname: Vannucci
authors.forename: R E
authors.initials: RE
authors.lastname: Fagley
authors.forename: M
authors.initials: M
authors.lastname: Doyle
authors.forename: S
authors.initials: S
authors.lastname: Shenoy
authors.forename: W
authors.initials: W
authors.lastname: Chapman
authors.forename: I
authors.initials: I
authors.lastname: Kangrga
mesh_terms: D001026:Coronary Artery Bypass; D006325:Heart Atria / Q000293:injuries*; D006801:Humans; D022125:Lacerations; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D019168:Portasystemic Shunt, Transjugular Intrahepatic