Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series

Tandon, Manish; Karna, Sunaina Tejpal; Pandey, Chandra Kant; Chaturvedi, Ravindra

doi:10.4254/wjh.v9.i33.1253

Cited by 12 publications

(12 citation statements)

References 25 publications

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“…103 After LT, the prevalence of cardiomyopathy and heart failure, defined by a decrease in the LV ejection fraction, has been reported in the 3 to 7% range. 106,107 Management of heart failure after LT does not differ from its usual management. In general, CCM normalizes after LT, but results have been mixed.…”

Section: Cardiovascular Management and Hemodynamicsmentioning

confidence: 99%

Perioperative Considerations in Liver Transplantation

Lopez

Steadman

Wray

et al. 2018

Semin Respir Crit Care Med

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Liver transplantation (LT) has the potential to cure patients with acute and chronic liver failure as well as a number of hepatic and biliary malignancies. Over time, due to the increasing demand for organs as well as improvements in the survival of LT recipients, patients awaiting LT have become sicker, and often undergo the procedure while critically ill. This trend has made the process of preoperative assessment and planning, intraoperative management, and postoperative management even more crucial to the success of LT programs. Multidisciplinary and specialized teams are essential and include anesthesiologists, surgeons, and intensivists. This article focuses on the preoperative evaluation, intraoperative care, and postoperative management of the liver transplant patient. Management relevant to the critically ill patient is discussed, with a focus on the management of postoperative cardiopulmonary conditions including the care of special populations such as those with hepatopulmonary syndrome and portopulmonary hypertension.

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Section: Cardiovascular Management and Hemodynamicsmentioning

confidence: 99%

Perioperative Considerations in Liver Transplantation

Lopez

Steadman

Wray

et al. 2018

Semin Respir Crit Care Med

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“…TS has most commonly been reported in elderly women with neurological or psychiatric disorders, but is increasingly being reported in postoperative patients [1,4]. Recently, several case series and retrospective studies have described TS in liver transplantation (LT) patients in the perioperative period [1,5]. In a retrospective, single-center study of 1752 liver transplants, the incidence of TS was found to be 1.4% [6].…”

Section: Introductionmentioning

confidence: 99%

“…Treatment for TS depends on severity and patient response to therapies. Strategies specific to managing acute left ventricular dysfunction in LT patients are not well-defined, but in general, first-line treatments for low cardiac output are diuretics, inotropic therapy, and vasopressors [5,7,[19][20][21]. If there is decreased perfusion secondary to vasoconstriction, first-line treatment should include vasodilators [22].…”

mentioning

confidence: 99%

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation – Which Came First?

et al. 2020

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Rare co-existance of disease or pathology Background: Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. Case Report: The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. Conclusions: It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.

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“…However, CCM often remains unrecognised when using traditional cardiovascular imaging modalities [15] and heart failure can be observed after LT even after all preoperative tests are negative [16]. Thus, newer more sensitive echocardiography indices as well as other imaging modalities, such as Cardiac Magnetic Resonance (CMR), are needed to improve the diagnostic approach of CCM, portopulmonary hypertension and other complications of end-stage-liver-disease.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives

Dimitroglou

Aggeli

Alexopoulou

et al. 2019

JCM

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Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications.

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Diagnostic and therapeutic challenge of heart failure after liver transplant: Case series

Cited by 12 publications

References 25 publications

Perioperative Considerations in Liver Transplantation

Perioperative Considerations in Liver Transplantation

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation – Which Came First?

Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives

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