Id. Harley et al., ORTHOTOPIC LIVER-TRANSPLANTATION IN 2 PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY, British Journal of Anaesthesia, 77(5), 1996, pp. 675-677
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.