Hemodynamic Changes during Hepatic Vascular Exclusion: Use of Intraoperative Transesophageal Echocardiography a Case Series

Abstract

The aim of this clinical observation was to compare intraoperative transesophageal echocardiography (TEE) and pulmonary artery catheterization (PAC) during hepatic vascular exclusion (HEV). Five non-cirrhotic patients to undergo HVE for major liver resection have been observed. Hemodynamic parameters: pulmonary arterial wedge pressure (PCWP), cardiac index (CI), cardiac output (CO), and systemic vascular resistance (SVR) have been monitored by PAC. Left ventricular end-diastolic area (LVEDA), left ventricular end-systolic area (LVESA), left ventricular end-diastolic pressure (LVEDP), cardiac index (CI), cardiac output (CO), and fractional area changes (FAC) have been monitored by TEE. Hemodynamic variables were assessed before clamping (), at 5 and 30 minutes after clamping (, ) and 15 minutes after unclamping (). No significant difference between PCWP and LVEDP was found. LVEDP significantly decreased at and compared to (); PCWP showed the same trend. A correlation was found between SV and LVEDP (, ) as well as CI (, ). Data confirm that intraoperative TEE may be a reliable method for hemodynamic monitoring during major liver resections.

Effect of intraoperative magnesium intravenous infusion on the hemodynamic changes associated with right lobe living donor hepatotomy under transesophageal Doppler monitoring-randomized controlled trial

“…demonstrated that the HR did increase after resection and that the MAP was not significantly changed similar to our results. [ 7 ] In this current study, MgSO 4 intravenous infusion was able to reduce this increase in HR. This finding could be explained by the stabilizing effect and the anti-arrthymoginic effect of magnesium.…”

“…also reported that the CO and CI increased after liver resection. [ 7 ] Several experimental studies had also shown that significant changes in hepatosplanchnic and systemic hemodynamics do happen after major hepatotomy, this could be due to rapid regenerative response and activity of the remnant liver parenchyma, with increased demand for oxygen consumption in relation to the extent of regeneration and consequently an increase in hepatosplanchnic blood flow, or to the significant increase in prostacyclin after hepatotomy. [ 9 10 11 ] In contrast to our current study findings, Boermeester et al .…”

Anesthetic Approach to a Case of Hepatoblastoma With Right Atrial Spread for Simultaneous Resection of Both

“…Activated clotting time monitoring when on cardiopulmonary bypass was carried out keeping possibilities of coagulopathy in mind. The patient was monitored for hemodynamic changes due to hepatic vascular exclusion, mechanical compression of IVC or right atrium, ischemia-reperfusion injury, and massive blood loss [8,9]. The risk of sudden massive pulmonary embolism was a real threat with a possibility of sudden cardiac arrest.…”