Cardiovascular manifestation of end-stage liver disease and perioperative echocardiography for liver transplantation: anesthesiologist’s view

Liver transplantation (LT) is the curative therapy for decompensated cirrhosis. However, anesthesiologists can find it challenging to manage patients undergoing LT due to the underlying pathologic conditions of patients with end-stage liver disease and the high invasiveness of the procedure, which is frequently accompanied by massive blood loss. Echocardiography is a non-invasive or semi-invasive imaging tool that provides real-time information about the structural and functional status of the heart and is considered to be able to improve outcomes by enabling accurate and detailed assessments. This article reviews the pathophysiologic changes of the heart accompanied by cirrhosis that mainly affect hemodynamics. We also present a comparative review of the diagnostic criteria for cirrhotic cardiomyopathy published by the World Congress of Gastroenterology in 2005 and the Cirrhotic Cardiomyopathy Consortium in 2019. This article discusses the conditions that could affect hemodynamic stability and postoperative outcomes, such as coronary artery disease, left ventricular outflow tract obstruction, portopulmonary hypertension, hepatopulmonary syndrome, pericardial effusion, cardiac tamponade, patent foramen ovale, and ascites. Finally, we cover a number of intraoperative factors that should be considered, including intraoperative blood loss, rapid reaccumulation of ascites, manipulation of the inferior vena cava, post-reperfusion syndrome, and adverse effects of excessive fluid infusion and transfusion. This article aimed to summarize the cardiovascular manifestations of cirrhosis that can affect hemodynamics and can be evaluated using perioperative echocardiography. We hope that this article will provide information about the hemodynamic characteristics of LT recipients and stimulate more active use of perioperative echocardiography.

Comparison of Functional Recovery Status according to Rehabilitation Therapy in Stroke Patients

OBJECTIVE: To investigate the effect of rehabilitation therapy on functional recovery in chronic stroke patients. METHOD: Brunnstrom stage for neurologic recovery, modified Barthel index (MBI) for functional recovery, and possi bility of gait were assessed in 66 chronic stroke patients. MBI and possibility of gait were compared the patients who received rehabilitation therapy (Rehab patients) with the patients who did not receive rehabilitation therapy (non- Rehab patients) in each Brunnsrom stage. RESULTS: In Brunnstrom stage III, 13 of 15 Rehab patients could walk 10 m or more, but none of 7 non-Rehab patients could walk independently, and this difference was statistically significant. MBI score was also significantly higher in Rehab patients than non-Rehab patients (71.3 vs 18.9, p=0.000) in Brunnstrom stage III. In Brunnstrom stage IV, V, VI, MBI score and possibility of gait were higher in Rehab patients than non-Rehab patients, but not significant. CONCLUSION: We can confirm the effect of rehabilitation therapy on functional recovery, and this effect seems to be more decisive in neurologically low recovery status patients.