Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22972
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dc.contributor.authorPearce, Brett-
dc.contributor.authorHu, Raymond T C-
dc.contributor.authorDesmond, Fiona-
dc.contributor.authorBanyasz, D-
dc.contributor.authorJones, Robert M-
dc.contributor.authorTan, Chong O-
dc.date2019-07-13-
dc.date.accessioned2020-04-14T04:01:25Z-
dc.date.available2020-04-14T04:01:25Z-
dc.date.issued2019-07-13-
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/22972-
dc.description.abstractTricuspid regurgitation (TR) and pulmonary hypertension (PHT) are highly dynamic cardiovascular lesions that may progress rapidly, particularly in the orthotopic liver transplantation (OLT) waitlist population. Severe TR and PHT are associated with poor outcomes in these patients, however it is rare for the two to be newly diagnosed intraoperatively at the time of OLT. Without preoperative information on pulmonary vascular and right heart function, the potential for reversibility of severe TR and PHT is unclear, making the decision to proceed to transplant fraught with difficulty. We present a case of successful orthotopic liver transplantation (OLT) in a 48 year old female with severe (PHT) (mean pulmonary arterial pressure > 55 mmHg) and severe TR diagnosed post induction of anaesthesia. The degree of TR was associated with systemic venous pressures of > 100 mmHg resulting in massive haemorrhage during surgery and difficulty in distinguishing venous from arterial placement of vascular access devices. Intraoperative transoesophageal echocardiography (TOE) proved crucial in diagnosing functional TR due to tricuspid annular and right ventricular (RV) dilatation, and dynamically monitoring response to treatment. In response to positioning, judicious volatile anaesthesia administration, pulmonary vasodilator therapy and permissive hypovolemia during surgery we noted substantial improvement of the TR and pulmonary arterial pressures, confirming the reversibility of the TR and associated PHT. TR and PHT are co-dependent, dynamic, load sensitive right heart conditions that are interdependent with chronic liver disease, and may progress rapidly in patients waitlisted for OLT. Use of intraoperative TOE and pulmonary artery catheterisation on the day of surgery will detect previously undiagnosed severe TR and PHT, enable rapid assessment of the cause and the potential for reversibility. These dynamic monitors permit real-time assessment of the response to interventions or events affecting right ventricular (RV) preload and afterload, providing critical information for prognosis and management. Furthermore, we suggest that TR and PHT should be specifically sought when waitlisted OLT patients present with hepatic decompensation.en_US
dc.language.isoeng-
dc.subjectCentral venous hypertensionen_US
dc.subjectLiver transplantationen_US
dc.subjectPulmonary artery catheteren_US
dc.subjectPulmonary hypertensionen_US
dc.subjectTrans-oesophageal echocardiography, case reporten_US
dc.subjectTricuspid regurgitationen_US
dc.titleIntraoperative TOE guided management of newly diagnosed severe tricuspid regurgitation and pulmonary hypertension during orthotopic liver transplantation: a case report demonstrating the importance of reversibility as a favorable prognostic factor.en_US
dc.typeMultimediaen_US
dc.identifier.affiliationVictorian Liver Transplant Uniten_US
dc.identifier.affiliationAnaesthesiaen_US
dc.identifier.affiliationAnaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, The University of Melbourne, Parkville, Australiaen_US
dc.identifier.affiliationDepartment of Surgery, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australiaen_US
dc.identifier.doi10.1186/s12871-019-0795-6en_US
dc.type.contentImageen_US
dc.identifier.orcid0000-0001-7703-3845en_US
dc.identifier.pubmedid31301738-
dc.type.austinCase Reports-
dc.type.austinJournal Article-
dc.type.austinVideo-Audio Media-
local.name.researcherDesmond, Fiona
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.languageiso639-1en-
item.openairetypeMultimedia-
crisitem.author.deptAnaesthesia-
crisitem.author.deptAnaesthesia-
crisitem.author.deptAnaesthesia-
crisitem.author.deptVictorian Liver Transplant Unit-
crisitem.author.deptSurgery (University of Melbourne)-
crisitem.author.deptHepatopancreatobiliary Surgery-
crisitem.author.deptGastroenterology and Hepatology-
crisitem.author.deptAnaesthesia-
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