Transesophageal echocardiography in orthotopic liver transplantation: a comprehensive intraoperative monitoring tool

Vetrugno, Luigi; Barbariol, Federico; Baccarani, Umberto; Forfori, Francesco; Volpicelli, Giovanni; Rocca, Giorgio Della

doi:10.1186/s13089-017-0067-y

Cited by 34 publications

(42 citation statements)

References 29 publications

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“…Depending on the center and the operator skills, esophageal varices may be considered a relative contraindication to TEU . However, in OLT candidates, TEE has been shown to be both safe and feasible.…”

Section: Teu Safety Of Usementioning

confidence: 99%

“…The lungs are scanned along the longitudinal axis from each of these landmarks by rotating the ultrasound plane at 0 and 90°. If we consider that moderate dyspnea is a common finding in patients with liver cirrhosis due to the compression of lung parenchyma by ascites and/or pleural effusion (eg, hydrothorax), and that hypoxia is relatively common following anesthesia induction, a quick examination of the lung is merited (Figure A,B) …”

Section: Transesophageal Lung Ultrasound (Telu)mentioning

confidence: 99%

“…Echocardiography features of the reperfusion phase may include acute right ventricular failure (see Movie ). TEE should thus be positioned in the mild esophageal four‐chambers view, and/or in the right inflow‐outflow view (50–70°) to allow for real time monitoring of the right free wall and the detection of intra‐cardiac air and thrombosis (see Movies ,) . The right ventricle is extremely sensitive to changes in loading conditions such as those that occur in the reperfusion phase, where three times more cardiac output crosses the cavity.…”

Section: Reperfusionmentioning

confidence: 99%

“…If the patient has left ventricular hypertrophy and long anterior mitral leaflet, left ventricular outflow tract obstruction (LVOTO) may occur (see Movies ,). In LVOTO, the anterior leaflet of the mitral valve can occlude left ventricle outflow, causing severe posterolateral mitral regurgitation flow . A retrospective review of 106 transplant recipients found inducible LVOTO on preoperative dobutamine stress echocardiography (DSE) in 40% of patients .…”

Section: Reperfusionmentioning

confidence: 99%

“…We previously described a case of ballooning syndrome with left ventricular acute failure associated with profound hypotension after liver reperfusion that fortunately restored after adrenalin bolus infusion, with the restoration of preload due to inferior vena cava reconstruction . This last scenario, known as Takotsubo cardiomyopathy, with transient left ventricular apical ballooning syndrome, is a reversible condition triggered by stressful events, such as the reperfusion of a transplanted liver or the exogenous administration of vasoactive medications.…”

Section: Reperfusionmentioning

confidence: 99%

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Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

et al. 2018

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The first perioperative transesophageal echocardiography (TEE) guidelines published 21 years ago were mainly addressed to cardiac anesthesiologists. TEE has since expanded its role outside this setting and currently represents an invaluable tool to assess chamber sizes, ventricular hypertrophy, and systolic, diastolic, and valvular function in patients undergoing orthotopic liver transplantation (OLT). Right-sided microemboli, right ventricular dysfunction, and patent foramen ovale (PFO) are the most common intra-operative findings described during OLT. However, left ventricular outflow tract obstruction and left ventricular ballooning syndrome are more difficult to recognize and less frequent. Transesophageal ultrasonography (TEU) during OLT is also underused. Its applications are as follows: (1) assistance in the difficult placement of pulmonary arterial catheters; (2) help with catheterization of great vessels for external veno-venous bypass placement; (3) intra-operative evaluation of surgical liver anastomosis patency, if feasible, through the liver window; and (4) intra-operative investigation of "acute hypoxemia" due to pulmonary and cardiac issues using trans-esophageal lung ultrasound (TELU). The aims of this review are as follows: (1) to summarize the uses of TEE and TEU throughout all phases of OLT, and (2) to describe other new feasible applications.

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Section: Teu Safety Of Usementioning

confidence: 99%

Section: Transesophageal Lung Ultrasound (Telu)mentioning

confidence: 99%

Section: Reperfusionmentioning

confidence: 99%

Section: Reperfusionmentioning

confidence: 99%

Section: Reperfusionmentioning

confidence: 99%

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Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

et al. 2018

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Safety and Benefit of Transesophageal Echocardiography in Liver Transplant Surgery: A Position Paper From the Society for the Advancement of Transplant Anesthesia (SATA)

Marchi¹,

Wang²,

Skubas

et al. 2020

Liver Transpl

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More anesthesiologists are routinely using transesophageal echocardiography (TEE) during liver transplant surgery, but the effects on patient outcome are unknown. Transplant anesthesiologists are therefore uncertain if they should undergo additional training and adopt TEE. In response to these clinical questions, the Society for the Advancement of Transplant Anesthesia appointed experts in liver transplantation and who are certified in TEE to evaluate all available published evidence on the topic. The aim was to produce a summary with greater explanatory power than individual reports to guide transplant anesthesiologists in their decision to use TEE. An exhaustive search recovered 51 articles of uncontrolled clinical observations. Topics chosen for this study were effectiveness and safety because they were a major or minor topic in all articles. The pattern of clinical use was a common topic and was included to provide contextual information. Summarized observations showed effectiveness as the ability to make a new and unexpected diagnosis and to direct the choice of clinical management. These were reported in each stage of liver transplant surgery. There were observations that TEE facilitated rapid diagnosis of life‐threatening conditions difficult to identify with other types of monitoring commonly used in the operating room. Real‐time diagnosis by TEE images made anesthesiologists confident in their choice of interventions, especially those with a high risk of complications such as use of anticoagulants for intracardiac thrombosis. The summarized observations in this systematic review suggest that TEE is an effective form of monitoring with a safety profile similar to that in cardiac surgery patients.

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Haemodynamic Monitoring During Liver Transplant Surgery

Blasi

Biancofiore

2020

Anesthesia for Hepatico-Pancreatic-Biliary Surgery and Transplantation

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Transesophageal echocardiography in orthotopic liver transplantation: a comprehensive intraoperative monitoring tool

Cited by 34 publications

References 29 publications

Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

Transesophageal ultrasonography during orthotopic liver transplantation: Show me more

Safety and Benefit of Transesophageal Echocardiography in Liver Transplant Surgery: A Position Paper From the Society for the Advancement of Transplant Anesthesia (SATA)

Haemodynamic Monitoring During Liver Transplant Surgery

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