Korean J Anesthesiol.  2005 Oct;49(4):558-562. 10.4097/kjae.2005.49.4.558.

Liver Transplantation and Nitric Oxide Treatment for a Patient with Severe Pulmonary Hypertension: A case report

• Kim GS
• Kim SJ
• Lee SM

• KMID: 1936863
• DOI: http://doi.org/10.4097/kjae.2005.49.4.558

Abstract

A 47-year-old male was admitted for superimposed acute alcoholic hepatitis with underlying alcoholic cirrhosis. His hospital course was complicated with poorly controlled ascites and pneumonia. He was admitted to intensive care unit for ventilator care and transferred to ward. Elective living-related liver transplantation was scheduled. After anesthetic induction, high pulmonary arterial pressures (82/38, mean 58 mmHg) were noticed via Swan-Ganz pulmonary catheter. Transesophageal echocardiography revealed minimal tricuspid and mitral regurgitation, left atrial enlargement, and slight paradoxical septal motion at apex. Surgery was postponed and he was revealed to be sensitive to NO inhalation. His hepatic encephalopathy was aggravated and liver transplantation was rescheduled. Intraoperative NO was delivered and operation was uneventful. Prostaglandin E1 was infused intraoperatively and postoperatively. He was extubated on 4th postoperative day and pulmonary arterial pressures monitoring was discontinued on 7th postoperative day. He was discharged home one month after transplantation without complication.

Keyword

liver transplantation; nitric oxide; pulmonary hypertension

MeSH Terms

Alprostadil
Arterial Pressure
Ascites
Catheters
Echocardiography, Transesophageal
Hepatic Encephalopathy
Hepatitis, Alcoholic
Humans
Hypertension, Pulmonary*
Inhalation
Intensive Care Units
Liver Cirrhosis, Alcoholic
Liver Transplantation*
Liver*
Male
Middle Aged
Mitral Valve Insufficiency
Nitric Oxide*
Pneumonia
Ventilators, Mechanical
Alprostadil
Nitric Oxide