Cardiac tamponade following liver transplantation after intrapericardial control of the suprahepatic vena cava.

Abstract

Transabdominal intrapericardial control of the suprahepatic inferior vena cava (SIVC) is a rather uncommon procedure occasionally required in conjunction with complicated liver transplantation (LT) and hepatobiliary surgery. Experience with this technique is limited. Here we report 6 cases of LT in which transabdominal intrapericardial control of the SIVC was necessary. After institutional review board approval was obtained, a single-center, retrospective review was conducted from January 1991 to December 2013 to identify adult cases (age > 18 years) of LT in which transabdominal intrapericardial isolation of the SIVC was necessary. Among 4102 adult LT cases in the study period, 6 such cases were identified. To gain access to the pericardial space, a 6- to 9-cm vertical incision was made above the SIVC. After reperfusion, the diaphragmatic incision was partially closed and selectively drained. Pericardial tamponade developed in 1 patient, and it necessitated emergent reoperation and widespread drainage. In conclusion, transabdominal intrapericardial isolation of the SIVC is easily achieved without the need for a separate thoracic incision. However, to be effective, the pericardial incision should be only partially closed, and the pericardial sac should be drained liberally. Such patients should be carefully monitored for signs and symptoms of pericardial tamponade, the development of which should prompt an immediate return to the operating room for emergent decompression and widespread drainage.

• Authors: Junming Xu, Johnny C Hong, Ronald W Busuttil
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 21 Issue 3 Pg. 339-43 (Mar 2015) ISSN: 1527-6473 [Electronic] United States
• PMID: 25408472 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2015 American Association for the Study of Liver Diseases.

Topics

• Adult
• Aged
• Cardiac Tamponade (diagnosis, etiology, surgery)
• Decompression, Surgical (methods)
• Drainage
• Female
• Humans
• Liver Transplantation (adverse effects, methods)
• Los Angeles
• Male
• Middle Aged
• Reoperation
• Retrospective Studies
• Risk Factors
• Treatment Outcome
• Vena Cava, Inferior (surgery)