title: Harmful effect of epinephrine on postreperfusion syndrome in an elderly liver transplantation recipient with sigmoid ventricular septum: A case report.
abstract: BACKGROUND
  As a common morphological change of aging heart, sigmoid ventricular septum is frequently found during routine preoperative evaluation, but often disregarded because of its little clinical importance. However, in this report, we describe a 70-year old patient with sigmoid ventricular septum who developed severe hemodynamic deterioration during liver transplantation because of its unique morphology of heart.
  
  
  METHODS
  During the course of reperfusion of the graft, patient's hemodynamics were closely monitored using transesophageal echocardiography.
  
  
  RESULTS
  Immediately after graft reperfusion, epinephrine was given as a treatment of choice for postreperfusion syndrome. Surprisingly, however, hemodynamic derangement persisted and became even worse. Intraoperative transesophageal echocardiography revealed left ventricular outflow tract obstruction resulting from systolic anterior motion of the mitral valve leaflet. Therefore, the patient was treated with phenylephrine and fluid bolus under the guidance of transesophageal echocardiography.
  
  
  CONCLUSIONS
  As more elderly recipient present for liver transplantation surgery nowadays, left ventricular outflow tract obstruction should always be considered as a possible cause for hemodynamic instability during reperfusion period. In addition, transesophageal echocardiography is a useful tool for both diagnosis of hemodynamic derangement and guidance for appropriate management during liver transplantation surgery.
authors: Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Young-Jin
authors: YJ
authors: Moon
authors: Ji Hyun
authors: JH
authors: Park
authors: JongEun
authors: J
authors: Oh
authors: Sooho
authors: S
authors: Lee
authors: Gyu-Sam
authors: GS
authors: Hwang
mesh_terms: D000368:Aged; D004452:Echocardiography; D004837:Epinephrine / Q000009:adverse effects*; D005440:Fluid Therapy; D006346:Heart Septum / Q000000981:diagnostic imaging; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D010656:Phenylephrine / Q000627:therapeutic use; D015424:Reperfusion / Q000009:adverse effects*; D013577:Syndrome; D014662:Vasoconstrictor Agents / Q000009:adverse effects* / Q000627:therapeutic use; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004837:Epinephrine