Koh HyunJung, Ahn Seulgi, Lee Jaemin
Department of Anesthesiology and Pain Medicine, Catholic University of Korea College of Medicine, Seoul, Korea.
Korean J Anesthesiol. 2015 Feb;68(1):83-6. doi: 10.4097/kjae.2015.68.1.83. Epub 2015 Jan 28.
Severe portopulmonary hypertension (PPHT) is considered a contraindication for liver transplantation (LT) because of the associated high mortality and poor prognosis. We report the case of a 57-year-old cirrhotic woman with severe PPHT (mean pulmonary artery pressure [mPAP] > 65 mmHg), who underwent a successful living donor LT. Intra-operative use of inhaled iloprost, milrinone, dobutamine, and postoperative use of inhaled nitric oxide and oral sildenafil failed to lower the pulmonary artery pressure (PAP). The patient responded only to nitroglycerin and drainage of massive ascites. Meticulous intra-operative volume control, which included minimizing blood loss and subsequent transfusion, was carried out. The use of vasopressors, which may have elevated the PAP, was strictly restricted. Intra-operative PAP did not show an increase, and the hemodynamics was maintained within relatively normal range, compared to the preoperative state. The patient was discharged without any complications or related symptoms.
重度门肺高压（PPHT）因相关的高死亡率和不良预后被视为肝移植（LT）的禁忌证。我们报告一例57岁患有重度PPHT（平均肺动脉压[mPAP]＞65 mmHg）的肝硬化女性患者，其接受了成功的活体供肝肝移植。术中使用吸入性伊洛前列素、米力农、多巴酚丁胺，术后使用吸入性一氧化氮和口服西地那非均未能降低肺动脉压（PAP）。患者仅对硝酸甘油和大量腹水引流有反应。术中进行了细致的容量控制，包括尽量减少失血及随后的输血。严格限制使用可能升高PAP的血管升压药。与术前状态相比，术中PAP未升高，血流动力学维持在相对正常范围内。患者出院时无任何并发症或相关症状。
