Sibulesky L, Peiris P, Taner CB, Kramer DJ, Canabal JM, Nguyen JH. Intraoperative intracardiac thrombosis in a liver transplant patient. World J Hepatol 2010; 2(5): 198-200 [PMID: 21160996 DOI: 10.4254/wjh.v2.i5.198]
Corresponding Author of This Article
Justin H Nguyen, MD, Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. nguyen.justin@mayo.edu
Article-Type of This Article
Case Report
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World J Hepatol. May 27, 2010; 2(5): 198-200 Published online May 27, 2010. doi: 10.4254/wjh.v2.i5.198
Intraoperative intracardiac thrombosis in a liver transplant patient
Lena Sibulesky, Prith Peiris, C Burcin Taner, David J Kramer, Juan M Canabal, Justin H Nguyen
Lena Sibulesky, C Burcin Taner, Justin H Nguyen, Department of Transplantation, Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, United States
Prith Peiris, Department of Anesthesiology, Mayo Clinic, Jacksonville, FL 32224, United States
David J Kramer, Juan M Canabal, Departments of Transplantation and Critical Care, Mayo Clinic, Jacksonville, FL 32224, United States
Author contributions: Sibulesky L, Peiris P and Nguyen JH collected and analyzed data and wrote the paper; Kramer DJ and Canabal JM analyzed data; and Taner CB participated in writing the paper.
Correspondence to: Justin H Nguyen, MD, Division of Transplant Surgery, Department of Transplantation, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States. nguyen.justin@mayo.edu
Telephone: +1-904-9563262 Fax: +1-904-9563359
Received: December 25, 2010 Revised: April 15, 2010 Accepted: April 22, 2010 Published online: May 27, 2010
Abstract
A 66-year-old female with cryptogenic cirrhosis complicated by ascites, hepatic encephalopathy, variceal bleeding and malnutrition with MELD of 34 underwent orthotopic deceased donor liver transplantation performed with piggyback technique. Extensive eversion thromboendovenectomy was performed for a portal vein thrombus which resulted in an excellent portal vein flow. The liver graft was recirculated without any hemodynamic instability. Subsequently, the patient became hypotensive progressing to asystole. She was resuscitated and a transesophageal probe was inserted which revealed a mobile right atrial thrombus and an underfilled poorly contractile right ventricle. The patient was noted to be coagulopathic at the time. She became progressively more stable with a TEE showing complete resolution of the intracardiac thrombus.
