Desai TV, Dhir A, Quan D, Zamper R. Intraoperative management of liver transplant in a patient with an undiagnosed ventricular septal defect: A case report. World J Anesthesiol 2021; 10(1): 1-6 [DOI: 10.5313/wja.v10.i1.1]
Corresponding Author of This Article
Tejal Vivek Desai, DA, DNB, MBBS, Doctor, Research Fellow, Department of Anesthesia and Perioperative Medicine, University Hospital, London Health Sciences Centre, 339 Windermere Road, London N6A 5A5, Ontario, Canada. tejaldesai7@gmail.com
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Anesthesiol. Oct 13, 2021; 10(1): 1-6 Published online Oct 13, 2021. doi: 10.5313/wja.v10.i1.1
Intraoperative management of liver transplant in a patient with an undiagnosed ventricular septal defect: A case report
Tejal Vivek Desai, Achal Dhir, Douglas Quan, Raffael Zamper
Tejal Vivek Desai, Achal Dhir, Raffael Zamper, Department of Anesthesia and Perioperative Medicine, University Hospital, London Health Sciences Centre, London N6A 5A5, Ontario, Canada
Douglas Quan, Department of General Surgery, University Hospital, London Health Sciences Centre, London N6A 5A5, Ontario, Canada
Author contributions: Desai TV, Dhir A and Zamper R were the patient’s anesthesiologists, contributed to manuscript drafting, and reviewed the literature. Zamper R analyzed and interpreted the Echocardiography images; Quan D was the patient’s transplant surgeon and contributed to manuscript drafting and revision; all authors issued final approval for the submitted version.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tejal Vivek Desai, DA, DNB, MBBS, Doctor, Research Fellow, Department of Anesthesia and Perioperative Medicine, University Hospital, London Health Sciences Centre, 339 Windermere Road, London N6A 5A5, Ontario, Canada. tejaldesai7@gmail.com
Received: June 7, 2021 Peer-review started: June 7, 2021 First decision: July 27, 2021 Revised: August 10, 2021 Accepted: September 26, 2021 Article in press: September 26, 2021 Published online: October 13, 2021
Core Tip
Core Tip: A liver transplant is a challenging case which can involve significant hemodynamic instability. It is also a situation where organ waitlists can prolong time to surgery leading to significant deterioration of the recipient’s condition. This can be compounded by any unexpected cardiac findings diagnosed in the immediate preoperative period by echocardiography. Our findings of a ventricular septal defect on transthoracic echocardiography (TTE) led to a clinical dilemma of proceeding with surgery knowing there was a risk of paradoxical embolism or hypoxemia. On the other hand, rejecting a matched donation after circulatory death liver graft would have been a waste of precious resources. By using intraoperative transesophageal echocardiography (TEE) we carefully titrated intraoperative hemodynamics and prevented intracardiac shunting. Our case highlights the importance of bedside TTE as well as intraoperative TEE in patients undergoing orthotopic liver transplants.
