1. Anesthetic Experience of Pediatric Living Donor Liver Transplantation with Hepatopulmonary syndrome after Repaired Tetralogy of Fallot kazumasa Hiroi, Takashi matsusaki, Mizuho Kaneda, Tomoyuki Kazumasa, Ryuji Kaku, Hiroshi Morimatsu Department of Anesthesiology and Resuscitology, Okayama University Hospital
腎移植 3時間9分
Roc. total dose ;202mg
Introduction & Challenging Point
History of Present Illness
Labo Data&Chest X-P &Perfusion Scintigraphy
Liver transplantation after congenital heart disease was so challenging in terms of hemodynamic management.
The diagnosis of Hepatopulmonary syndrome (HPS) and the adaptation of liver transplantation had been discussed carefully by cardiologist, transplant surgical team and anesthesiologists.
Challenging Point
Massive bleeding by comprehensive operative technique due to visceral heterotaxia
Severe hypoxia due to heart failure with massive transfusion.
Circulatory and respiratory dysfunction by reperfusion injury
His hypoxia got worse and he newly needed home oxygen therapy (SpO2 82% with oxygen supplementation).
He had no residual disease after a corrective surgery for tetralogy of Fallot by echocardiogram.
Hepatopulmonary syndrome (HPS) was confirmed by a contrast-enhanced echocardiogram and a lung perfusion scan demonstrating the presence of significant intrapulmonary shunting.
His progressing hypoxia due to HPS needed additional therapy and we thought that liver transplantation (LDLT from her mother) was the only way to rescue his life.
Plt
115,000
/μl
AST 83
U/l
BNP
330.7
pg/ml
PT-INR
1.14
ALT 51 Na
134
mmol/l
APTT
36.2
sec
ALP
1,405 K
4.0 TP
5.7
g/dl
T-Bil
2.54
mg/dl Cl
106
Alb
3.5
D-Bil
1.35
Pulmonary Arterial Contrast
Discusiion
We have prepared for inhalational NO preventing form progressing hypoxia by massive transfusion or reperfusion injury.
Our cardiovascular surgical staff waited in case of using cardiopulmonary bypass according to severe hypoxia or circulatory collapse.
Anesthesia Record
O2 (l/min) 6
1.1
Air (l/min)
1.9
Sevoflurane (%) 1 2
Fentanyl (mcg) 40 20 50
Case Description
BP(mmHg)
HR(/min)
SpO2 (%)
/ total 600ml
2-years-10-month-old male
Height 83cm Body weight: 9.2kg
Diagnosis: Biliatry Atresia
Medical History:
Kasai surgery (day 46)
corrective surgery for tetralogy of Fallot
Other complication
visceral heterotaxia, polysplenia,
deficit of inferior vena cava
bilateral superior vena cava
Conclusion
We have successfully managed living donor liver transplantation with congenital heart disease.
It was important that perioperative team prepared for the predictable event of emergency in the perioperative care disease. × ◎ ◎ × 1 2 3 4 5 6 7 8 9
Bleeding(ml)l
240
430
730
1085
1260
1555
1850
RCC (ml) 50
FFP (ml) 40