Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation
Intraoperative Transesophageal Echocardiography (TEE) during orthotopic liver transplant (OLT) is used to gather real-time information on cardiovascular function and intravascular volume status. We report a case where nonstandard TEE views were used to inspect the hepatic vasculature after allograft...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2019/5293069 |
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| author | Narjeet Khurmi Mitchell Seman Brantley Gaitan Scott Young David Rosenfeld Emmanouil Giorgakis Winston Hewitt Amit Mathur |
| author_facet | Narjeet Khurmi Mitchell Seman Brantley Gaitan Scott Young David Rosenfeld Emmanouil Giorgakis Winston Hewitt Amit Mathur |
| author_sort | Narjeet Khurmi |
| collection | DOAJ |
| description | Intraoperative Transesophageal Echocardiography (TEE) during orthotopic liver transplant (OLT) is used to gather real-time information on cardiovascular function and intravascular volume status. We report a case where nonstandard TEE views were used to inspect the hepatic vasculature after allograft implantation. A 29-year-old male with secondary biliary cirrhosis with a MELD score of 20 underwent OLT using a liver from a 21-year-old brain-dead donor. Postreperfusion TEE, using the modified hepatic vein views, confirmed the presence of an inferior vena cava (IVC) suprahepatic anastomotic stenosis and hepatic vein and IVC thrombus resulting in hepatic venous outflow obstruction, allograft congestion, and hemodynamic instability. These nonstandard TEE images established the extent of suprahepatic caval outflow obstruction, in which intraoperative ultrasound was unable to definitively demonstrate. This guided real-time surgical decision-making in the postimplantation phase of the operation—ultimately leading to hepatic vein and IVC thrombectomy and revision of suprahepatic caval anastomosis. |
| format | Article |
| id | doaj-art-16ea33b8efa6499cb6301fb81d77b751 |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-16ea33b8efa6499cb6301fb81d77b7512025-08-20T03:54:32ZengWileyCase Reports in Transplantation2090-69432090-69512019-01-01201910.1155/2019/52930695293069Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver TransplantationNarjeet Khurmi0Mitchell Seman1Brantley Gaitan2Scott Young3David Rosenfeld4Emmanouil Giorgakis5Winston Hewitt6Amit Mathur7Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USADepartment of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USAIntraoperative Transesophageal Echocardiography (TEE) during orthotopic liver transplant (OLT) is used to gather real-time information on cardiovascular function and intravascular volume status. We report a case where nonstandard TEE views were used to inspect the hepatic vasculature after allograft implantation. A 29-year-old male with secondary biliary cirrhosis with a MELD score of 20 underwent OLT using a liver from a 21-year-old brain-dead donor. Postreperfusion TEE, using the modified hepatic vein views, confirmed the presence of an inferior vena cava (IVC) suprahepatic anastomotic stenosis and hepatic vein and IVC thrombus resulting in hepatic venous outflow obstruction, allograft congestion, and hemodynamic instability. These nonstandard TEE images established the extent of suprahepatic caval outflow obstruction, in which intraoperative ultrasound was unable to definitively demonstrate. This guided real-time surgical decision-making in the postimplantation phase of the operation—ultimately leading to hepatic vein and IVC thrombectomy and revision of suprahepatic caval anastomosis.http://dx.doi.org/10.1155/2019/5293069 |
| spellingShingle | Narjeet Khurmi Mitchell Seman Brantley Gaitan Scott Young David Rosenfeld Emmanouil Giorgakis Winston Hewitt Amit Mathur Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation Case Reports in Transplantation |
| title | Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation |
| title_full | Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation |
| title_fullStr | Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation |
| title_full_unstemmed | Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation |
| title_short | Nontraditional Use of TEE to Evaluate Hepatic Vasculature and Guide Surgical Management in Orthotopic Liver Transplantation |
| title_sort | nontraditional use of tee to evaluate hepatic vasculature and guide surgical management in orthotopic liver transplantation |
| url | http://dx.doi.org/10.1155/2019/5293069 |
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