Utilization of Intraoperative TEE to Assess Supraventricular Tachycardia-Inducing Right-Sided Cardiac Compression by the Liver, Post-Liver-Transplantation Status

Abstract

This unique and interesting case report involves a patient who recently underwent a combined liver and kidney transplant (due to autosomal dominant polycystic kidney disease) and subsequently suffered from episodes of supraventricular tachycardia (SVT) secondary to the new liver graft compressing the right atrium and ventricle. After this was diagnosed, the patient underwent operative plication of the right hemidiaphragm. Intraoperative transesophageal echocardiography was used to demonstrate cardiac compression from the liver and demonstrate resolution of compression after plication of the hemidiaphragm.

Nontraditional Transesophageal Echocardiographic Views to Evaluate Hepatic Vasculature in Orthotopic Liver Transplantation and Liver Resection Surgery

“…Utilizing a ME bicaval view with a slight rightward turn and advancement of the probe, they were able to visualize and evaluate the “piggyback technique” of anastomoses following OLT. Stoll et al 15 in a case report described a unique view revealing the cause of recurrent supraventricular tachycardia due to extrinsic compression of the right atrium by the liver and diaphragm in a post-liver transplant case. In that case, a ME 4 chamber view, and a ME 5 chamber view with an omniplane angle of 70° were used to guide surgical plication of the diaphragm in real time, ultimately alleviating the recurrent supraventricular tachycardia.…”

Intraoperative Transesophageal Echocardiography: Review and Evolution

“…This symptomatic myocardial compression by the liver was guided and confirmed via RT-TEE imaging with a successful resolution [50]. Even in obstetric surgery, Cho et al reported a rare case of abrupt hemodynamic instability in a woman during a vaginal hysterectomy, iTEE was performed and a right atrium thrombus was identified [51].…”