ORTHOTOPIC LIVER-TRANSPLANTATION IN 2 PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

Orthotopic liver transplantation (OLT) in patients with end-stage live r disease is a procedure associated with high cardiac output, low syst emic vascular resistance (SVR), coagulopathy and the potential for sig nificant blood loss, A feature of hypertrophic obstructive cardiomyopa thy (HOCM) is left ventricular outflow tract obstruction which may be exacerbated by reduced SVR, reduced filling pressures, tachycardia and positive inotropy. We report two cases of OLT in patients with HOCM. Our anaesthetic technique involved the use of halothane and vecuronium and avoidance of drugs causing tachycardia and positive inotropy. Man agement was aided by intraoperative transoesophageal echocardiography which showed that filling pressures poorly reflected end-diastolic vol umes. Volume administration, vasoconstrictors and avoidance of inotrop es and chronotropes reduced the outflow tract obstruction which was pa rticularly severe in the reperfusion period.