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Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantation

Published in Journal of clinical anesthesia. 2006, vol. 18, no. 5, p. 367-71
Abstract Severe pulmonary thromboembolism has been occasionally reported during orthotopic liver transplantation, with fatal outcomes occurring in about 50% of cases because of low cardiac output and multiple organ failure. Perioperative alterations in coagulation, insertion of pulmonary artery and other invasive catheters, administration of antifibrinolytic agents, and repeated ischemic insults may all promote the formation of intravascular/cardiac blood clots. We present a case of intraoperative right ventricular failure associated with the presence of a large thrombus wrapped around the pulmonary artery catheter. Identification of risk factors for intraoperative pulmonary thromboembolism warrants a prophylactic medical approach including selective blood component therapy and administration of antifibrinolytics guided by bedside coagulation tests as well as noninvasive hemodynamic monitoring.
Keywords Aprotinin/administration & dosage/adverse effectsBlood PressureBronchodilator Agents/administration & dosageCardiotonic Agents/administration & dosageCatheterization, Swan-Ganz/adverse effectsEchocardiography, TransesophagealFemaleHeart Ventricles/ultrasonographyHemostatics/administration & dosage/adverse effectsHumansIntraoperative Complications/diagnosis/drug therapy/etiologyLiver Transplantation/adverse effectsLypressin/administration & dosage/analogs & derivativesMiddle AgedMilrinone/administration & dosageNitric Oxide/administration & dosagePlatelet Aggregation Inhibitors/administration & dosagePlatelet Transfusion/adverse effectsPulmonary Embolism/complications/diagnosis/drug therapyVentricular Dysfunction, Right/diagnosis/drug therapy/etiology
PMID: 16905083
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Article (Published version) (326 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Research groups Dysfonctions cardio-pulmonaires et cérébrales (278)
Hépatologie chirurgicale (327)
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ELLENBERGER, Christoph et al. Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantation. In: Journal of clinical anesthesia, 2006, vol. 18, n° 5, p. 367-71. doi: 10.1016/j.jclinane.2005.10.007 https://archive-ouverte.unige.ch/unige:36674

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Deposited on : 2014-05-16

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