Analysis of the Right Ventricular Pressure/Volume Relationship and Contractility During Liver Transplantation / 대한마취과학회지

ABSTRACT

BACKGROUND: Hemodynamic instability is one of the main concerns for anesthesiologists during orthotopic liver transplantation (OLTX). The most troublesome event would be an increase of central venous pressure associated with sudden right ventricular (RV) filling without any change in heart contractility. An acute increase in RV outflow pressure depresses RV contractility and eventually causes overt RV failure. To avoid such disaster, it would be wise to evaluate right heart pressure/volume relationship and assess contractility when anticipating acute increase of pressure in right heart chamber. METHODS: RV function was assessed in 15 patients undergoing OLTX. RV function was monitored using an ejection fraction catheter and a monitor. Complete hemodynamic profile was obtained on regular intervals. Statistical analysis was performed using ANOVA for repeated measures. Correlation between variables were determined by simple regression analysis and ANCOVA. RESULTS: RV end-diastolic volume was in the range of supranormal values. No correlation was observed between right atrial pressure and RV end-diastolic volume index (RVEDVI). There was a significant correlation between stroke index and RVEDVI. RV ejection fraction and E-single were relatively constant throughout the procedure. There was weak negative correlation between E-signle and RVEDVI. CONCLUSION: RV function appeared to be well preserved during OLTX. However, RV contractility tends to decrease in response to RVEDV increase because RVEDV of endstage liver disease might increase to their maximal value. Right heart filling pressure was less reliable clinical indicator of RV preload.