VENTRICULAR-FUNCTION DURING LIVER REPERFUSION IN HEPATIC TRANSPLANTATION - A TRANSESOPHAGEAL ECHOCARDIOGRAPHIC STUDY

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.