title: Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction.
abstract: Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period.
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Essandoh
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Andrew Joseph
authors.initials: AJ
authors.lastname: Otey
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Dalia
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dewhirst
authors.affiliation: Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Springer
authors.affiliation: Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, OH , USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Henry
keywords: dynamic left ventricular outflow tract obstruction; mitral regurgitation; paradoxical hypotension; postreperfusion syndrome; systolic anterior motion of the mitral valve; transesophageal echocardiography