This Article Résumé de cet Article Full Text Full Text (PDF) Additional Material Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Jacobsohn, E. Articles by De Wet, C. J. Search for Related Content PubMed PubMed Citation Articles by Jacobsohn, E. Articles by De Wet, C. J.

Case report: Inferior vena-cava right atrial anastomotic stenosis after bicaval orthotopic heart transplantation

[Présentation de cas : sténose anastomotique auriculaire droite de la veine cave inférieure à la suite d’une transplantation cardiaque orthotopique bicave]

Eric Jacobsohn, FRCPC^*, Michael S. Avidan, MBBCh FCA^*, Charles B. Hantler, MD, Frank Rosemeier, MD and Charl J. De Wet, MBChB^*

^* From the Departments of Anesthesiology and Surgery, and the
Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA.

Address correspondence to: Dr. Eric Jacobsohn, Washington University School of Medicine, Department of Anesthesiology, 660 S. Euclid Ave – Campus Box 8054, St Louis, MO 63110, USA. Phone: 314-747-4155; Fax: 314-747-3977; E-mail: jacobsoe{at}msnotes.wustl.edu

Purpose: This case report describes the occurrence of acute postoperative liver and renal failure after bicaval orthotopic heart transplantation (OHT) due to stenosis of the inferior vena cava (IVC)-right atrial (RA) anastomosis. We also discuss the role of measuring femoral venous pressure and transesophageal echocardiography (TEE) in establishing the diagnosis.

Clinical features: A 42-yr-old female patient with idiopathic dilated cardiomyopathy underwent an OHT, using the bicaval anastomotic technique. During the first 12 hr postoperatively she developed unexplained kidney and liver failure. Her left and right ventricular functions were excellent and the right and left sided filling pressures were normal. The femoral pressure was elevated while the RA pressure was normal. An emergent TEE showed colour-flow and Doppler characteristics consistent with IVC-RA anastomotic stenosis. Emergent surgical re-exploration was undertaken; a hemostatic suture was found at the RA cannulation site that had caused the constriction of the IVC-RA anastomosis.

Conclusions: Acute liver and renal failure after OHT can have multiple causes including ischemia due to a low flow state. This case demonstrates the importance of doing a detailed intraoperative TEE after OHT, and the importance of repeating the intraoperative examination after any hemostatic sutures are placed. Femoral venous pressure monitoring can be a useful diagnostic tool in detecting IVC-RA stenosis.