Right Heart Dysfunction, Pulmonary Embolism, and Paradoxical Embolization during Liver Transplantation: A Transesophageal Two‐Dimensional Echocardiographic Study

In 16 adult patients, we performed continuous intraopcrative two-dimensional transesophageal echocardiography (2DTEE) to help elucidate the mechanism of rnyocardial dysfunction that accompanies liver transplantation. In 4 of the 16 patients “paradoxical” motion of the interventricular septum consistent with right ventricular failure was seen. An additional three of the 16 patients showed right atrial enlargement and right-to-left deviation of the interatrial septum. Two patients showed evidence of paradoxical embolization (one of whom had right ventricular and right atrial enlargement), and a third patient (who had right atrial enlargement) embolized a large right atrial thrombus into the pulmonary circulation. Two-dimensional transesophageal echocardiography demonstrated that isolated right ventricular failure might account for some of the hemodynamic instability seen during liver transplantation. Venous, pulmonary, and paradoxical embolization of air and thrombi documented by transesophageal echocardiography likely contribute to right heart failure.

[1]  M. Pinsky,et al.  Cardiovascular Depression Secondary to Ionic Hypocalcemia during Hepatic Transplantation in Humans , 1986, Anesthesiology.

[2]  S. Kaul.  The interventricular septum in health and disease. , 1986, American heart journal.

[3]  E. Botvinick,et al.  Poor Correlation Between Pulmonary Arterial Wedge Pressure and Left Ventricular End-diastolic Volume after Coronary Artery Bypass Graft Surgery , 1986, Anesthesiology.

[4]  E. Kochs,et al.  [Detection of venous embolism during intraoperative monitoring by two-dimensional transesophageal echocardiography]. , 1985, Anasthesie, Intensivtherapie, Notfallmedizin.

[5]  D. Cortese,et al.  Pulmonary aspects of chronic liver disease and liver transplantation. , 1985, Mayo Clinic proceedings.

[6]  F. Carmichael,et al.  Anesthesia for Hepatic Transplantation: Cardiovascular and Metabolic Alterations and their Management , 1985, Anesthesia and analgesia.

[7]  B. Griffith,et al.  Venous Bypass in Clinical Liver Transplantation , 1984, Annals of surgery.

[8]  W. Zapol,et al.  Thromboxane mediates acute pulmonary hypertension in sheep extracorporeal perfusion. , 1982, The American journal of physiology.

[9]  R. Bedford,et al.  Hemodynamics during anesthesia in the seated position , 1982 .

[10]  T. Starzl,et al.  Acute Neurological Complications After Liver Transplantation with Particular Reference to Intraoperative Cerebral Air Embolus , 1978, Annals of surgery.

[11]  J. Seward,et al.  Detecting intrapulmonary right-to-left shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas. , 1976, Mayo Clinic proceedings.

[12]  W. Longmire,et al.  Vasodepressive effects of the venous effluent following canine liver allotransplantation. , 1968, The Journal of surgical research.