Intraoperative transesophageal echocardiography reveals thrombotic stenosis of inferior vena cava during orthotopic liver transplantation

Usefulness of intraoperative transesophageal echocardiography for hemodynamic management of liver transplantation in a patient with massive polycystic liver disease: a case report

“…However, TEE can provide additional information otherwise difficult to detect. TEE during liver transplantation can not only detect dynamic left ventricular outflow obstruction and intracardiac air embolism but also provide extracardiac information such as IVC stenosis [ 8 ]. In our case, TEE revealed that hemodynamic instability during the dissection phase was due to IVC collapse associated with mechanically enlarged polycystic liver displacement.…”

“…Because PLD is often complicated by polycystic kidney disease, maintaining venous perfusion may be renoprotective in terms of avoiding renal congestion. Aubuchon et al reported the detection of thrombotic stenosis of the IVC during liver transplantation in PLD [ 8 ], but there is no report that TEE detected IVC collapse due to mechanical displacement of the giant cystic liver. In this case, TEE was also useful for the early detection of right intrathoracic hemorrhage.…”

Perioperative Evaluation and Management of Patients With Portopulmonary Hypertension Aiming for Orthotopic Liver Transplantation

“…19 Other applications of TEE include placement of venovenous bypass cannula (again not an issue with the "piggy-back" technique), identification of hemodynamically significant thrombosis of the IVC, intracardiac thrombus, complications of transjugular intrahepatic portosystemic shunts, and management of patients with underlying valvular heart disease, coronary artery disease, or cardiomyopathy (eg, alcohol-induced, hemochromatosis, or amyloidosis). [20][21][22][23] During the anhepatic phase, there are predictable hemodynamic changes including decreased systemic vascular resistance and increased CO, MPAP, and PVR. The TEE assessment should be focused on determining ventricular dysfunction and volume status.…”

Use, Training, and Opinions About Effectiveness of Transesophageal Echocardiography in Adult Liver Transplantation Among Anesthesiologists in the United States

“…In contrast, there are no required TEE training pathways for anesthesiologists without cardiac anesthesiology fellowships. [3][4][5] The use of TEE during adult liver transplant is well described, [6][7][8][9][10][11][12][13][14][15][16] but there is insufficient evidence about its benefits and effectiveness in clinical care 17 and there is no unified approach to minimal competency for transplant anesthesiologists. The Society for the Advancement of Transplant Anesthesia (SATA) has responded to this ambiguity by creating a Working Group on TEE.…”