G. Delamorena et al., VENTRICULAR-FUNCTION DURING LIVER REPERFUSION IN HEPATIC TRANSPLANTATION - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY, Transplantation, 58(3), 1994, pp. 306-310
Postreperfusion syndrome (PRS) is the most dramatic and acute hemodyna
mic alteration that occurs in OLT. Our aim was to determine heart func
tion by hemodynamic monitoring and transesophageal echocardiography du
ring PRS. We studied 24 nonconsecutive patients allocated to 2 groups:
group A (n=8), patients with PRS, and group E (n=16), patients withou
t PRS. Usual hemodynamic data were obtained simultaneously with transe
sophageal echocardiography recording of the left ventricular imaging i
n 4 different stages: after induction of anesthesia, 5 min before the
end of the anhepatic phase, between 2 and 5 min after reperfusion, and
5 min after graft reperfusion. The hemodynamic and echocardiographic
findings during reperfusion were (group A vs. group B patients): mean
arterial pressure, 50.0+/-15.2 vs. 74.7+/-13.9 mmHg (P<0.01); pulmonar
y capillary wedge pressure, 12.7+/-6.1 vs. 13.9+/-5.7 mmHg (NS); left
ventricular ejection fraction, 79.6+/-9.3 vs. 83.4+/-9.4% (NS); left v
entricular end diastolic volume index, 35.5+/-12.7 vs. 54.7+/-21.3 ml/
m(2) (P<0.05); and stroke volume index, 27.91+/-8.9 vs. 45.5+/-15.9 ml
/m(2) (P<0.01). There was a mild decrease in left ventricular complian
ce in group A. We found no alteration in left ventricular function tha
t can justify PRS. The hemodynamic changes during PRS seemed to be cau
sed by an insufficient increase in preload after unclamping.