Da Costa Rodrigues Joao, Gazarian Corinne, Maillard Julien, Albu Gergely, Assouline Benjamin, Lador Frédéric, Schiffer Eduardo
Division of Anesthesiology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Division of Intensive Care Medicine, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
Am J Case Rep. 2025 Feb 1;26:e946268. doi: 10.12659/AJCR.946268.
BACKGROUND Portopulmonary hypertension (POPH) is part of Group 1 of the clinical classification of pulmonary hypertension and represents 5-15% of patients with pulmonary hypertension, with a 5-year mortality rate of 40%. The implementation of preoperative pulmonary antihypertensive treatment allows liver transplantation depending on clinical response, which constitutes potential curative treatment. Uncontrolled pulmonary hypertension is a major risk factor of perioperative morbimortality in the context of liver transplantation. In case of major hemodynamic instability, extracorporeal membrane oxygenation (ECMO) can be placed to manage circulatory failure. We describe a case of a patient with POPH in whom an emergency ECMO was implanted during liver transplantation complicated by an intraoperative worsening of pulmonary vascular resistances leading to cardiac arrest. CASE REPORT A 16-year-old patient with POPH had an orthotopic liver transplantation (OLT) after management of pulmonary hypertension with a triple antihypertensive therapy, which was complicated by hemorrhagic shock. Management of hemorrhagic shock led to greatly increased pulmonary vascular resistances, which led to a perioperative cardiac arrest, necessitating the implantation of a veno-arterial ECMO, allowing the completion of critical surgical steps before admission to the intensive care unit. CONCLUSIONS POPH is a challenge in the perioperative setting. OLT is a therapeutic option in that setting. ECMO may be necessary for patients with POPH in the perioperative hemodynamic management during OLT. In highly selected cases, VA-ECMO implantation and timing should be discussed by a multidisciplinary team before induction. The emergency perioperative implantation of ECMO is a realistic alternative.
门肺高压（POPH）是肺动脉高压临床分类中第1组的一部分，占肺动脉高压患者的5%-15%，5年死亡率为40%。术前进行肺抗高血压治疗可根据临床反应进行肝移植，这是一种潜在的治愈性治疗方法。未控制的肺动脉高压是肝移植围手术期发病和死亡的主要危险因素。在出现严重血流动力学不稳定的情况下，可放置体外膜肺氧合（ECMO）来处理循环衰竭。我们描述了一例门肺高压患者，该患者在肝移植术中因肺血管阻力恶化导致心脏骤停，紧急植入了ECMO。
一名16岁的门肺高压患者在接受三联抗高血压治疗以控制肺动脉高压后进行了原位肝移植（OLT），但出现了失血性休克。失血性休克的处理导致肺血管阻力大幅增加，进而导致围手术期心脏骤停，因此需要植入静脉-动脉ECMO，以便在进入重症监护病房之前完成关键的手术步骤。
门肺高压在围手术期是一项挑战。OLT是该情况下的一种治疗选择。在OLT围手术期血流动力学管理中，ECMO可能对门肺高压患者是必要的。在高度选择的病例中，多学科团队应在诱导前讨论VA-ECMO的植入和时机。围手术期紧急植入ECMO是一种现实的选择。
