Detailed Abstract
[Poster - Transplantation]
[P051] Successful ldlt in a case of mean pulmonary arterial pressure of 52 mmhg
Yang Won NAH1, Hyung Woo PARK1, Jin A KWON1, In Young HUH2, Sun Eun PARK2, Seo Hee AHN3, Shin Jae KIM3
1Department of Surgery, Ulsan University Hospital, Korea
2Department of Anesthesiology, Ulsan University Hospital, Korea
3Department of Cardiology, Ulsan University Hospital, Korea, Korea
Introduction : Pulmonary hypertension (PH) is defined as an elevated mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest. Krowka reported that mPAP of 50 mmHg or greater was associated with 100% cardiopulmonary mortality in liver transplantation (LT) setting.
Methods : A 45 years old male patient underwent LDLT for HBV + alcoholic cirrhosis and HCC. MELD score was 28. Echocardiography showed right ventricular systolic pressure (RVSP) 62 mmHg, suggesting moderate resting PH. During anesthetic induction, mPAP was measured as 52mmHg. With infusion of Isosorbide, mPAP decreased to 40. Vital signs were stable and PaO2 level was 223 mmHg. So we decided to proceed with surgery despite of moderate PH.
Results : The LDLT procedure was done with modified right lobe graft. mPAP was in the range of 46~31. Alprostadil was started after finishing arterial anastomosis and was infused for 7 days thereafter. The day after LT, RVSP was 96 mmHg. And 5 days after LT, he complained of dyspnea and Beraprost (prostacyclin pathway agonist) was given orally. The patient was discharged 19 days after LT. 6 weeks after LT RVSP was measured as 84 mmHg. mPAP was 63 mmHg on right heart catheterization. On CT scan, there was marked hepatic congestion resulting from PH. Endothelin receptor antagonist Ambrisentan was given orally. The patient's breathing difficulty almost disappeared soon. Now, 5 months after the operation, he returned to work.
Conclusions : When encountered a case of moderate to severe pulmonary hypertension during LT, initial response to anesthetic management might dictate whether to proceed with LT or not.
Methods : A 45 years old male patient underwent LDLT for HBV + alcoholic cirrhosis and HCC. MELD score was 28. Echocardiography showed right ventricular systolic pressure (RVSP) 62 mmHg, suggesting moderate resting PH. During anesthetic induction, mPAP was measured as 52mmHg. With infusion of Isosorbide, mPAP decreased to 40. Vital signs were stable and PaO2 level was 223 mmHg. So we decided to proceed with surgery despite of moderate PH.
Results : The LDLT procedure was done with modified right lobe graft. mPAP was in the range of 46~31. Alprostadil was started after finishing arterial anastomosis and was infused for 7 days thereafter. The day after LT, RVSP was 96 mmHg. And 5 days after LT, he complained of dyspnea and Beraprost (prostacyclin pathway agonist) was given orally. The patient was discharged 19 days after LT. 6 weeks after LT RVSP was measured as 84 mmHg. mPAP was 63 mmHg on right heart catheterization. On CT scan, there was marked hepatic congestion resulting from PH. Endothelin receptor antagonist Ambrisentan was given orally. The patient's breathing difficulty almost disappeared soon. Now, 5 months after the operation, he returned to work.
Conclusions : When encountered a case of moderate to severe pulmonary hypertension during LT, initial response to anesthetic management might dictate whether to proceed with LT or not.
SESSION
Poster
Poster / Exhibition Hall and Lobby(2F) 1/1/1970 9:00 AM - 9:00 AM