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Cho MK, Kwon JH, Gwak MS, Joh JW, Hwang J, Kim GS. Liver transplantation in an adult patient with hepatocellular carcinoma following liver cirrhosis as a complication of the Fontan procedure -A case report. Anesth Pain Med (Seoul) 2020; 15:466-471. [PMID: 33329850 PMCID: PMC7724127 DOI: 10.17085/apm.20037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 01/23/2023] Open
Abstract
Background Fontan-associated liver disease (FALD) is a hepatic disorder caused by hemodynamic changes and systemic venous congestion following the Fontan procedure. FALD includes liver cirrhosis and hepatocellular carcinoma (HCC), both of which may require liver transplantation (LT). However, the Fontan circulation, characterized by elevated central venous pressure and reduced cardiac output, is a challenging issue for surgeons and anesthesiologists. Case We report a living-donor LT for the treatment of HCC. The patient was a 24-year-old male who underwent the Fontan procedure for pulmonary atresia and right ventricle hypoplasia. We focused on maintaining enough blood volume for cardiac output without causing pulmonary edema, as the patient is not well adapted to changes in volume. Owing to a multidisciplinary approach, the surgery was successfully performed without fatal adverse events. Conclusions To our knowledge, this is the first case of isolated LT in a recipient who became an adult after having undergone the Fontan procedure.
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Affiliation(s)
- Min-Kyung Cho
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sook Gwak
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - JiYun Hwang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaab Soo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yamada Y, Hoshino K, Oyanagi T, Gatayama R, Maeda J, Katori N, Fuchimoto Y, Hibi T, Shinoda M, Matsubara K, Obara H, Aeba R, Kitagawa Y, Yamagishi H, Kuroda T. Successful management of living donor liver transplantation for biliary atresia with single ventricle physiology-from peri-transplant through total cavopulmonary connection: A case report. Pediatr Transplant 2018; 22:e13118. [PMID: 29457852 DOI: 10.1111/petr.13118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/05/2023]
Abstract
Children with single ventricle physiology have complete mixing of the pulmonary and systemic circulations, requiring staged procedures to achieve a separation of these circulations, or Fontan circulation. The single ventricle physiology significantly increases the risk of mortality in children undergoing non-cardiac surgery. As liver transplantation for patients with single ventricle physiology is particularly challenging, only a few reports have been published. We herein report a case of successful LDLTx for an 8-month-old pediatric patient with biliary atresia, heterotaxy, and complex heart disease of single ventricle physiology. The cardiac anomalies included total anomalous pulmonary venous return type IIb, intermediate atrioventricular septal defect, tricuspid regurgitation grade III, coarctation of aorta, interrupted inferior vena cava, bilateral superior vena cava, and polysplenia syndrome. Following LDLTx, the patient sequentially underwent total cavopulmonary shunt + Damus-Kaye-Stansel at 3 years of age and extracardiac total cavopulmonary connection (EC-TCPC) completion at 5 years of age; 7 years have now passed since LDLTx (2 years post-EC-TCPC). We describe the details of the management of LTx in the presence of cardiac anomalies and report the long-term cardiac and liver function, from peri-LDLTx through EC-TCPC completion.
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Affiliation(s)
- Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ken Hoshino
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Oyanagi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Ryohei Gatayama
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Jun Maeda
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Katori
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Ryo Aeba
- Department of Cardiac Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yamagishi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo, Japan
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Brito MM, Seda Neto J, Fonseca EA, Pugliese R, Danesi VB, Candido HL, Porta A, Borges CVB, Porta G, Chapchap P, Miura IK. Outcomes of liver transplantation in pediatric recipients with cardiovascular disease. Pediatr Transplant 2018; 22. [PMID: 29131462 DOI: 10.1111/petr.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
Abstract
LT exerts considerable stress on the heart perioperatively. Limited data exist on impact of cardiovascular diseases on LT children. This study evaluated the outcomes of children with CVD who underwent LT and compared with pretransplant findings. From 518 LT recipients, 82 (15.8%) had CVD. Sixty patients were classified as low-risk adjustment for congenital heart surgery 1 (RACHS 1 and 2). Five patients were classified as RACHS ≥3. The most common echocardiographic finding in the CVD patients (25/82) was ASD. CVD patients had more abnormal EKG (32.4% vs 14.5%, P < .001), abnormal chest X-ray (11.8% vs 1.4%, P < .001), and altered echocardiography (89.7% vs 15.4%, P < .001) findings compared with the No-CVD group pretransplant. Post-transplant, significant differences between groups were observed related to abnormal EKG (14.7% vs 7.0%, P = .03) and echocardiography (48.5% vs 3.2%, P < .01) findings. Pretransplant ASD spontaneously closed in 22 patients. At 1 and 5 years post-transplant, there was no difference in the survival rate between groups (P = .96). The prevalence of CVD in recipients of LT was high, and its presence was associated with significantly higher cardiac decompensation before and after LT. Minor and moderate cardiovascular disease did not impact the long-term survival.
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Affiliation(s)
| | - Joao Seda Neto
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Eduardo A Fonseca
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Renata Pugliese
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Vera B Danesi
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Helry L Candido
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Adriana Porta
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Cristian V B Borges
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - Gilda Porta
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | | | - Irene Kazue Miura
- Hospital Sirio-Libanes, Sao Paulo, SP, Brazil.,A. C. Camargo Cancer Center, Sao Paulo, SP, Brazil
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Kawabata S, Sakamoto S, Honda M, Hayashida S, Yamamoto H, Mikami Y, Inomata Y. Liver transplantation for a patient with Turner syndrome presenting severe portal hypertension: a case report and literature review. Surg Case Rep 2016; 2:68. [PMID: 27358061 PMCID: PMC4927526 DOI: 10.1186/s40792-016-0194-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 06/21/2016] [Indexed: 01/15/2023] Open
Abstract
Background Liver involvement in Turner syndrome (TS) patients has been more clearly clarified in recent years. Most of the clinical manifestations in TS are asymptomatic and can be detected as liver test abnormalities; however, a few cases may present with end-stage liver disease and thus require liver transplantation (LT). To the best of our knowledge, only three cases undergoing LT for liver involvements in TS have been previously reported. Case presentation A 30-year-old female successfully underwent living donor LT for liver dysfunction related to TS syndrome. The diagnosis of TS was established by a cytogenetic analysis at 16 years of age. She received several sessions of endoscopic therapy for recurrent esophageal varices, which was complicated by ascites and spontaneous bacterial peritonitis since 27 years of age. Radiological findings of her liver before LT chronologically showed the progression of atrophy with disturbance of the major portal inflow. And then, she was finally indicated for LT. Pathologic findings of the explanted liver showed vascular abnormalities, obliterative portal venopathy, which may have induced liver dysfunction with severe portal hypertension. The patient’s postoperative course was uneventful. Conclusions The clinicopathologic information obtained by the current case can provide an insight into understanding pathophysiological mechanisms of liver involvement in TS patients. TS patients presenting with severe liver atrophy and disturbance of the major portal inflow should be indicated for LT.
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Affiliation(s)
- Seiichi Kawabata
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Seisuke Sakamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan. .,Division of Transplant Surgery, Organ Transplantation Center, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masaki Honda
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Shintaro Hayashida
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Hidekazu Yamamoto
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Yoshiki Mikami
- Department of Pathology, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
| | - Yukihiro Inomata
- Department of Transplantation and Pediatric Surgery, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 862-8556, Japan
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Youn JK, Lee JM, Yi NJ, Choi YR, Suh SW, You T, Lee KW, Jung CW, Lee JW, Bae EJ, Ko JS, Kim WH, Park KW, Suh KS. Pediatric split liver transplantation after Fontan procedure in left isomerism combined with biliary atresia: a case report. Pediatr Transplant 2014; 18:E274-9. [PMID: 25263970 DOI: 10.1111/petr.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2014] [Indexed: 11/29/2022]
Abstract
LI is a subset of the heterotaxy syndrome and a rare birth defect that involves the heart and other organs. It can be combined with extracardiac abnormalities, especially BA. CHD can be associated with LI in up to 15% of cases, although it is rare in BA. Pediatric LT for a child with ESLD due to BA combined with LI and CHD is a challenging issue for a transplant surgeon. Herein, we report a successful split LT on a three-yr-old boy with LI who survived after a Fontan procedure due to single ventricle, but who suffered from HPS associated with BA.
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Affiliation(s)
- Joong Kee Youn
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Haida H, Aeba R, Hoshino K, Morikawa Y. Fontan completion in a patient with previous liver transplantation. Interact Cardiovasc Thorac Surg 2014; 19:705-7. [PMID: 24997187 DOI: 10.1093/icvts/ivu216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present the first case of a successful Fontan completion in a patient with previous liver transplantation. An infant with polysplenia syndrome with a functional single ventricle and biliary atresia had been surgically managed by pulmonary artery banding, Kasai operation and living donor liver transplantation. Subsequently, the patient successfully underwent bidirectional cavopulmonary shunt and total cavopulmonary connection with extracardiac conduit at 3 and 5 years of age, respectively.
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Affiliation(s)
- Hirofumi Haida
- Division of Cardiovascular Surgery, Keio University, Shinjuku, Japan
| | - Ryo Aeba
- Division of Cardiovascular Surgery, Keio University, Shinjuku, Japan
| | - Ken Hoshino
- Division of Pediatric Surgery, Keio University, Shinjuku, Japan
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Feier FH, Neto JS, Porta G, Fonseca EA, Vincenzi R, Cândido HL, Benavides M, Ketzer B, Pugliese R, Miura IK, Baggio V, Guimarães T, Porta A, Foronda G, Donizete E, da Silva JP, Faria L, Kondo M, Chapchap P. Liver transplantation after stage II palliation for hypoplastic left heart syndrome. Liver Transpl 2013; 19:322-7. [PMID: 23239564 DOI: 10.1002/lt.23593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 11/25/2012] [Indexed: 01/12/2023]
Abstract
The association of biliary atresia (BA) with congenital heart diseases has been extensively described, and there are a number of reports on the outcomes of patients in this group who undergo liver transplantation (LT). The intraoperative management and the timing of LT for patients with end-stage liver disease are matters of debate, especially when complex heart diseases are involved. This report describes the outcome after LT for a pediatric recipient with BA and hypoplastic left heart syndrome. The patient underwent Norwood-Sano and Glenn procedures for heart palliation before LT. He was cyanotic, was severely malnourished, and had complications secondary to chronic liver failure. At the time of transplantation, the child was 16 months old and weighed 5175 g. Despite the critical clinical scenario and the long hospitalization period, there were no cardiac, vascular, or biliary complications after LT. At the age of 48 months, the patient was awaiting the final cardiac repair. In conclusion, the presence of complex cardiac malformations may not be a contraindication to LT. An experienced surgical team and a multidisciplinary approach are key to a successful outcome.
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Affiliation(s)
- Flavia H Feier
- Hepatology and Liver Transplantation Unit, Sírio-Libanês Hospital, São Paulo, Brazil
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Asrani SK, Asrani NS, Freese DK, Phillips SD, Warnes CA, Heimbach J, Kamath PS. Congenital heart disease and the liver. Hepatology 2012; 56:1160-9. [PMID: 22383293 DOI: 10.1002/hep.25692] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 02/19/2012] [Indexed: 01/05/2023]
Abstract
There are approximately 1 million adult patients with congenital heart disease (CHD) in the United States, and the number is increasing. Hepatic complications are common and may occur secondary to persistent chronic passive venous congestion or decreased cardiac output resulting from the underlying cardiac disease or as a result of palliative cardiac surgery; transfusion or drug-related hepatitis may also occur. The unique physiology of Fontan circulation is particularly prone to the development of hepatic complications and is, in part, related to the duration of the Fontan procedure. Liver biochemical test abnormalities may be related to cardiac failure, resulting from intrinsic liver disease, secondary to palliative interventions, or drug related. Complications of portal hypertension and, rarely, hepatocellular carcinoma (HCC) may also occur. Abnormalities such as hypervascular nodules are often observed; in the presence of cirrhosis, surveillance for HCC is necessary. Judicious perioperative support is required when cardiac surgery is performed in patients with advanced hepatic disease. Traditional models for liver disease staging may not fully capture the severity of disease in patients with CHD. The effectiveness or safety of isolated liver transplantation in patients with significant CHD is limited in adults; combined heart-liver transplantation may be required in those with decompensated liver disease or HCC, but experience is limited in the presence of significant CHD. The long-term sequelae of many reparative cardiac surgical procedures are not yet fully realized; understanding the unique and diverse hepatic associations and the role for early cardiac transplantation in this population is critical. Because this population continues to grow and age, consideration should be given to developing consensus guidelines for a multidisciplinary approach to optimize management of this vulnerable population.
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Affiliation(s)
- Sumeet K Asrani
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Bibliography. Current world literature. Cardiovascular medicine. Curr Opin Pediatr 2007; 19:601-6. [PMID: 17885483 DOI: 10.1097/mop.0b013e3282f12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To summarize results of recent papers and discuss current trends concerning anesthesia in children with congenital heart disease presenting for noncardiac surgery. RECENT FINDINGS Children with congenital heart disease have a significant incremental risk when presenting for minor or major surgery. It is a current trend that noncardiac surgery should be performed in pediatric centers, which have anesthesiologists and pediatricians familiar with the multiple specialties of children with congenital heart disease. A careful preoperative evaluation using a multidisciplinary approach is of great importance. In recent studies and case reports, the safe use of newer anesthetic agents, such as sevoflurane or desflurane, was reported in combination with opioids or regional blocks. In addition to standard monitors, invasive monitoring should be considered liberally perioperatively in patients with limited hemodynamic reserve and with major surgery. Several case reports reported that laparoscopic surgery was successfully performed even in high-risk patients with congenital heart disease. SUMMARY Careful preoperative evaluation, experienced anesthesiologists, suitable anesthetic agents and techniques, and the liberal use of invasive monitoring are integral parts of safe and effective anesthetic care in children with congenital heart disease. Future studies have to show whether laparoscopic surgery may be beneficial in this special subgroup of patients.
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Affiliation(s)
- Robert Sümpelmann
- Zentrum Anästhesiologie, Medizinische Hochschule Hannover, Hannover, Germany.
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