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CARDIOVASCULAR ANESTHESIA

Diagnosis and Treatment of Intracardiac Thrombosis During Orthotopic Liver Transplantation

Raymond M. Planinsic, MD^*, Ramona Nicolau-Raducu, MD^*, Bijan Eghtesad, MD, and Amadeo Marcos, MD

Departments of *Anesthesiology and Surgery, University of Pittsburgh Medical Center, Pennsylvania

Address correspondence and reprint requests to Raymond M. Planinsic, MD, Director of Hepatic Transplantation Anesthesiology, University of Pittsburgh Medical Center, 200 Lothrop St., Room C-207, Pittsburgh, PA 15213. Address e-mail to planinsicrm{at}anes.upmc.edu

Intracardiac thrombus formation during orthotopic liver transplantation can be a catastrophic event leading to death. Most often this devastating complication occurs after reperfusion and may be related to massive blood transfusion, marginal liver grafts, tendencies towards hypercoagulability, or the potential role of antifibrinolytics. We report a case of an intracardiac thrombus occurring during the hepatectomy stage (stage I) of orthotopic liver transplantation. Transesophageal echocardiography was used to quickly diagnose the thrombus, allowing rapid pharmacological intervention and later guide surgical evacuation of the intracardiac thrombus via the inferior vena cava.

IMPLICATIONS: Intracardiac thrombosis occurring during liver transplantation can be a catastrophic event leading to death. Understanding the causes and treatment of hypercoagulability during liver transplantation is important to reduce the risk of this complication.

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