Right Heart Dysfunction, Pulmonary Embolism, and Paradoxical Embolization during Liver Transplantation

Intraoperative pulmonary embolism and intracardiac thrombosis complicating liver transplantation: a systematic review

“…However, in the current review of 74 patients with PE and/or ICT, 34 (46%) did not receive any antifibrinolytic drug [13,15,16,20,22,24,27,36,40,41,43]. These numbers may even be influenced by a reporting bias, as it is likely that thrombotic complications are less frequently reported when no potential cause can be identified or when no antifibrinolytic drug is given to the patient.…”

“…The first cases of PE were reported by Kang et al [15] in 1987, and the most recent was described by Hudcova et al [16] in 2006. Of these 74 cases, 43 cases were described in 21 case reports [13,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35], 21 were documented in four abstracts [36][37][38][39] and 10 cases were identified within a series of patients undergoing OLT [15,[40][41][42][43][44][45]. In this study we only included central venous thromboembolic complications occurring during the transplant procedure itself.…”

“…The most frequently described risk factors were venovenous bypass [13,15,18,[23][24][25]29,30,32,[34][35][36][38][39][40]45] and the use of antifibrinolytic medication [13,17,19,21,23,25,26,[28][29][30][31][32][34][35][36][37][38][39][42][43][44]. However, PE and ICT have been reported in almost an identical number of patients with or without these two putative risk factors (Table 3).…”

Transesophageal echocardiography and orthotopic liver transplantation: General concepts

“…Graft reperfusion may lead to severe hypotension, usually the result of dramatic vasodilation, but in some patients, contractility changes are suspected to occur. [4][5][6] Echogenic contrast material is seen entering the heart from the inferior vena cava on reperfusion in every patient, 4 but clinically significant air embolism after reperfusion is uncommon.…”

“…7 TEE may also help in the identification of the exact hemodynamic changes during postreperfusion syndrome. 8,9 In addition, TEE has been used in the diagnosis and management of intraoperative complications, such as air embolism, 10 thromboembolism, 4,11,12 and the management of patients with unrelated cardiopulmonary disease, such as coronary artery disease, valvular pathological states, or idiopathic hypertrophic subaortic stenosis. [13][14][15] Other patients with alcoholinduced cardiomyopathy, hemochromatosis, amyloidosis, or Wilson' s disease may benefit from intraoperative TEE monitoring.…”