title: The evolution of diastolic function during liver transplantation.
abstract: BACKGROUND
  The peroperative management of liver transplantation is still associated with many cardiocirculatory complications in which diastolic dysfunction may play a contributive role. Transoesophageal echocardiography is a monitoring device commonly used in liver transplantation allowing diastolic function assessment.
  
  
  METHODS
  We prospectively analysed the peroperative transoesophageal echocardiography recordings of 40 patients undergoing liver transplantation in order to describe changes in diastolic function at different steps of the surgery. The diastolic function marker we used was the lateral mitral annulus motion (E' wave velocity) obtained by tissue-Doppler imaging. In addition, we also studied the left ventricular filling pressure indices and systolic function.
  
  
  RESULTS
  As a whole, there was no global change in E' wave velocity throughout the surgery. However, 11 patients (27.5%) presented a decrease in E' wave velocity up to 15% that identified an occurrence of diastolic function alteration. In this group, other peroperative data were not different from other patients (amount of bleeding, fluid administration or vasopressive support). Conversely, this group experienced lower preoperative E' wave velocity values (9cm·s-1versus 12cm·s-1, P=0.05) and an increased incidence of postoperative cardiorespiratory complications (OR=6 [1-56], P=0.02). Considering all patients, 18 patients had an E' wave velocity under 10cm·s-1at unclamping, characterizing a diastolic dysfunction according to the usual criteria. This dysfunction was not associated with cardiorespiratory complications.
  
  
  CONCLUSIONS
  This work investigated peroperative systematic echocardiographic evaluation of diastolic function during liver transplantation. Diastolic dysfunction occurs frequently during liver transplantation and could lead to postoperative cardiorespiratory complications.
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France. Electronic address: pauline.devauchelle@chu-lyon.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Devauchelle
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Zoé
authors.initials: Z
authors.lastname: Schmitt
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bonnet
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Duperret
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Viale
authors.affiliation: Department of general and hepatobiliary surgery, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Aubrun
authors.affiliation: Department of anaesthesiology, Croix-Rousse hospital, hospices civils de Lyon, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Gazon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D003971:Diastole; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications / Q000453:epidemiology; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control; D012120:Respiration Disorders / Q000453:epidemiology / Q000209:etiology; D016277:Ventricular Function, Left; D055815:Young Adult
keywords: Cardiac function; Echocardiography; Haemodynamic; Reperfusion