Transesophageal Echocardiography Utilization in High-Volume Liver Transplantation Centers in the United States

Wax, David B.; Torres, Antonio; Scher, Corey S.; Leibowitz, Andrew B.

doi:10.1053/j.jvca.2008.07.007

Cited by 76 publications

(36 citation statements)

References 19 publications

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“…It also permits reevaluation of the recipient's cardiac function at the start of surgery, which would highlight deterioration since previous assessment. A limiting factor over its use however, is the training required for competent scanning and interpretation of images [83] . There is also the small risk of bleeding from oesophageal varices.…”

Section: Haemodynamic Monitoringmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

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Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation of the myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of the β-adrenergic receptor. Diagnosis can be made using a combination of echocardiography (resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. Core tip: Cirrhotic cardiomyopathy is characterised by a blunted inotropic and chronotropic response to stress, impaired diastolic relaxation and prolongation of the QT interval. It is only recently that it has been recognised as a definitive clinical entity, and yet it has significant implications in a number of clinical situations in which there is increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Liver transplantation is one such situation, and in this review we discuss criteria for diagnosis, possible methods to limit further deterioration and the perioperative management of these patients.

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Section: Haemodynamic Monitoringmentioning

confidence: 99%

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Rahman

Mallett

2015

WJH

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“…However the use of TEE during OLT is a matter of debate and practice varies. 3,4 For noncardiac surgery, the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists (SCA) guidelines recommend TEE be used where the surgery or patient’s cardiovascular pathology might result in severe hemodynamic, pulmonary or neurological compromise. 4 They also recommend that if equipment and expertise are available TEE should be used when unexplained life threatening circulatory instability persists despite corrective therapy.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting During Liver Transplantation

Badenoch

Srinivas

Al‐Adra

et al. 2017

Transplantation Direct

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“…Training is not available in every transplantation center. In a survey by Wax et al, transplantation centers in the United States with more than 50 OLTs per year were surveyed about their TEE utilization [13]. Eighty-six percent of the anesthesiologists performed TEE in some or all OLT cases; however, most of them performed a limited scope examination.…”

Section: Discussionmentioning

confidence: 99%

Early echocardiographic detection of a massive intracardiac thrombus in a patient scheduled for orthotopic liver transplantation

Mutlak

Wilke

Moench

et al. 2012

Journal of Clinical Anesthesia

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Transesophageal Echocardiography Utilization in High-Volume Liver Transplantation Centers in the United States

Cited by 76 publications

References 19 publications

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients

A Case Report of Paradoxical Air Embolism Caused by Intrapulmonary Shunting During Liver Transplantation

Early echocardiographic detection of a massive intracardiac thrombus in a patient scheduled for orthotopic liver transplantation

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