Division of Solid Organ Transplantation, Department of Anesthesiology, Preoperative Medicine and Pain Management, University of Miami Leonard M. Miller School of Medicine, Miami, FL 33136, USA.
Clin Transplant. 2010 Jul-Aug;24(4):515-9. doi: 10.1111/j.1399-0012.2009.01119.x.
The incidence of porto-pulmonary hypertension (PPHN) in patients with end stage liver disease is 8.5%. Evidence indicates that proceeding with orthotopic liver transplantation (OLT) in patients diagnosed with severe PPHN (mean pulmonary artery pressure [mPAP]>45 mmHg) at the time of OLT surgery is associated with high perioperative mortality. We describe a case of severe PPHN that was diagnosed by right heart catheterization at the time of surgery. We quickly determined the reversibility of PPHN with a bolus of milrinone and proceeded with OLT. Further episodes of pulmonary hypertension were successfully managed with continuous milrinone infusion and transesophageal echocardiography monitoring. Reversibility via vasodilator trial after identification of high pulmonary artery pressures (PAP) may be an important indication of the feasibility of OLT. Milrinone may be useful for the rapid identification of the reversibility of high PAP and may be an effective agent to control abrupt increases in PAP during OLT.
终末期肝病患者发生门肺高压（PPHN）的概率为 8.5%。有证据表明，对于在原位肝移植（OLT）手术时已诊断为严重 PPHN（平均肺动脉压[mPAP]＞45mmHg）的患者，继续进行 OLT 手术与围手术期高死亡率相关。我们描述了一例在手术时通过右心导管检查诊断为严重 PPHN 的病例。我们通过米力农推注快速确定 PPHN 的可逆性，并继续进行 OLT。通过持续米力农输注和经食管超声心动图监测成功管理了进一步的肺动脉高压发作。在识别出肺动脉高压（PAP）高后通过血管扩张剂试验来确定可逆性可能是 OLT 可行性的重要指标。米力农可能有助于快速确定高 PAP 的可逆性，并可能是控制 OLT 期间 PAP 突然升高的有效药物。
