en
Scientific article
Case report
English

Cardiovascular collapse due to massive pulmonary thromboembolism during orthotopic liver transplantation

Published inJournal of clinical anesthesia, vol. 18, no. 5, p. 367-371
Publication date2006
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 effects
  • Blood Pressure
  • Bronchodilator Agents/administration & dosage
  • Cardiotonic Agents/administration & dosage
  • Catheterization, Swan-Ganz/adverse effects
  • Echocardiography, Transesophageal
  • Female
  • Heart Ventricles/ultrasonography
  • Hemostatics/administration & dosage/adverse effects
  • Humans
  • Intraoperative Complications/diagnosis/drug therapy/etiology
  • Liver Transplantation/adverse effects
  • Lypressin/administration & dosage/analogs & derivatives
  • Middle Aged
  • Milrinone/administration & dosage
  • Nitric Oxide/administration & dosage
  • Platelet Aggregation Inhibitors/administration & dosage
  • Platelet Transfusion/adverse effects
  • Pulmonary Embolism/complications/diagnosis/drug therapy
  • Ventricular Dysfunction, Right/diagnosis/drug therapy/etiology
Citation (ISO format)
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. 367–371. doi: 10.1016/j.jclinane.2005.10.007
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Article (Published version)
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Identifiers
ISSN of the journal0952-8180
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