title: Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation.
abstract: METHODS
  Female, 54 FINAL DIAGNOSIS: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly
  
  
  METHODS
  - Clinical Procedure: - Specialty: Transplantology • Critical Care Medicine.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the "piggyback" technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain.
  
  
  METHODS
  We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time.
  
  
  CONCLUSIONS
  Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications.
authors.affiliation: Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara Jalisco, México ; Investigación en Microbiología Médica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara Jalisco, México.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Aguirre-Avalos
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Covarrubias-Velasco
authors.forename: Antonio Gerardo
authors.initials: AG
authors.lastname: Rojas-Sánchez
keywords: acute cor pulmonale; liver transplantation; portopulmonary hypertension; pulmonary arterial hypertension; suprahepatic inferior vena cava
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