Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation: A case report and review of the literature

Youri Vater, Kenneth Martay, Gregory Dembo, T. Andrew Bowdle, Avi A. Weinbroum

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Background: The presence of pulmonary hypertension in patients scheduled for liver transplantation requires a comprehensive perioperative heart evaluation and treatment with epoprostenol (prostacycline) infusion until a liver donor becomes available. We contended that intraoperative attenuation of severe pulmonary hypertension could be achieved by epoprostenol infusion combined with nitric oxide inhalation. Case Report: A 49 years old man with end stage liver disease secondary to hepatitis C and ethanol abuse presented for orthotopic liver transplantation. The case was complicated by severe pulmonary hypertension. Preoperative epoprostenol, at doses ranging from 6 to 26 ng·kg-1·min-1, was infused during the induction of anesthesia. Although lower than before (>70 mmHg), post-induction pulmonary pressure (by Swan-Ganz catheter) was 62/30 mmHg. Prior to surgical incision nitric oxide (NO) by inhalation was commenced, increasing the concentration from 10 to 40 ppm; pulmonary artery pressure (PAP) then declined to 55/25 mmHg. Before starting reperfusion of the transplanted liver, NO concentration was increased to 80 ppm: this allowed completion of the procedure with PAP at 32/16 mmHg. Real time transesophageal echocardiography indicated improvement in right heart function due to NO. Following surgery, NO was continued for 10 hs at a concentration of 40 ppm and the patient was then extubated. Epoprostenol infusion was continued for 2 months after the patient was discharged home; last PAP was measured 32/10 mmHg. Conclusions: Severe intraoperative pulmonary hypertension during liver transplantation was successfully treated using the combination of IV epoprostenol infusion and NO inhalation in medium and high concentrations.

Original languageEnglish (US)
Pages (from-to)CS115-CS118
JournalMedical Science Monitor
Volume12
Issue number12
StatePublished - Dec 1 2006

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Epoprostenol
Pulmonary Hypertension
Liver Transplantation
Nitric Oxide
Inhalation
Pulmonary Artery
Pressure
End Stage Liver Disease
Liver
Transesophageal Echocardiography
Hepatitis C
Reperfusion
Ethanol
Catheters
Anesthesia
Tissue Donors
Lung

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Vater, Youri ; Martay, Kenneth ; Dembo, Gregory ; Bowdle, T. Andrew ; Weinbroum, Avi A. / Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation : A case report and review of the literature. In: Medical Science Monitor. 2006 ; Vol. 12, No. 12. pp. CS115-CS118.
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Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation : A case report and review of the literature. / Vater, Youri; Martay, Kenneth; Dembo, Gregory; Bowdle, T. Andrew; Weinbroum, Avi A.

In: Medical Science Monitor, Vol. 12, No. 12, 01.12.2006, p. CS115-CS118.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Intraoperative epoprostenol and nitric oxide for severe pulmonary hypertension during orthotopic liver transplantation

T2 - A case report and review of the literature

AU - Vater, Youri

AU - Martay, Kenneth

AU - Dembo, Gregory

AU - Bowdle, T. Andrew

AU - Weinbroum, Avi A.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - Background: The presence of pulmonary hypertension in patients scheduled for liver transplantation requires a comprehensive perioperative heart evaluation and treatment with epoprostenol (prostacycline) infusion until a liver donor becomes available. We contended that intraoperative attenuation of severe pulmonary hypertension could be achieved by epoprostenol infusion combined with nitric oxide inhalation. Case Report: A 49 years old man with end stage liver disease secondary to hepatitis C and ethanol abuse presented for orthotopic liver transplantation. The case was complicated by severe pulmonary hypertension. Preoperative epoprostenol, at doses ranging from 6 to 26 ng·kg-1·min-1, was infused during the induction of anesthesia. Although lower than before (>70 mmHg), post-induction pulmonary pressure (by Swan-Ganz catheter) was 62/30 mmHg. Prior to surgical incision nitric oxide (NO) by inhalation was commenced, increasing the concentration from 10 to 40 ppm; pulmonary artery pressure (PAP) then declined to 55/25 mmHg. Before starting reperfusion of the transplanted liver, NO concentration was increased to 80 ppm: this allowed completion of the procedure with PAP at 32/16 mmHg. Real time transesophageal echocardiography indicated improvement in right heart function due to NO. Following surgery, NO was continued for 10 hs at a concentration of 40 ppm and the patient was then extubated. Epoprostenol infusion was continued for 2 months after the patient was discharged home; last PAP was measured 32/10 mmHg. Conclusions: Severe intraoperative pulmonary hypertension during liver transplantation was successfully treated using the combination of IV epoprostenol infusion and NO inhalation in medium and high concentrations.

AB - Background: The presence of pulmonary hypertension in patients scheduled for liver transplantation requires a comprehensive perioperative heart evaluation and treatment with epoprostenol (prostacycline) infusion until a liver donor becomes available. We contended that intraoperative attenuation of severe pulmonary hypertension could be achieved by epoprostenol infusion combined with nitric oxide inhalation. Case Report: A 49 years old man with end stage liver disease secondary to hepatitis C and ethanol abuse presented for orthotopic liver transplantation. The case was complicated by severe pulmonary hypertension. Preoperative epoprostenol, at doses ranging from 6 to 26 ng·kg-1·min-1, was infused during the induction of anesthesia. Although lower than before (>70 mmHg), post-induction pulmonary pressure (by Swan-Ganz catheter) was 62/30 mmHg. Prior to surgical incision nitric oxide (NO) by inhalation was commenced, increasing the concentration from 10 to 40 ppm; pulmonary artery pressure (PAP) then declined to 55/25 mmHg. Before starting reperfusion of the transplanted liver, NO concentration was increased to 80 ppm: this allowed completion of the procedure with PAP at 32/16 mmHg. Real time transesophageal echocardiography indicated improvement in right heart function due to NO. Following surgery, NO was continued for 10 hs at a concentration of 40 ppm and the patient was then extubated. Epoprostenol infusion was continued for 2 months after the patient was discharged home; last PAP was measured 32/10 mmHg. Conclusions: Severe intraoperative pulmonary hypertension during liver transplantation was successfully treated using the combination of IV epoprostenol infusion and NO inhalation in medium and high concentrations.

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