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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2013;8(1):40-46.
Published online January 31, 2013.
Relationship of preoperative echocardiography and circulation in living donor liver transplantation
Ji Yong Kim, Sang Hyun Hong, Stephanie Youna Kim, Keon Hee Ryu, Chul Soo Park
Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Echocardiography has been routinely performed before liver transplantation to screen perioperative risks due to cardiovascular complications. However, only limited echocardiographic indices have been used and have become familiar with clinicians. Here we aimed to evaluate the relationship between preoperative echocardiography and circulatory manifestations during living donor liver transplantation (LDLT).
Perioperative data including preoperative echocardiographic indices and intraoperative circulatory manifestations from 159 LDLT recipients (> or =18 years) were retrospectively collected. Relationships between individual echocardiographic indices and intraoperative circulatory manifestations were assessed by Pearson or Spearman correlation test. Intraoperative circulatory manifestations showing potential correlation with echocardiographic indices (r > or = 0.2 or < or =-0.2) were additionally analyzed by unpaired t or chi-square test after their dichotomizations at clinically meaningful cutoffs.
Strong correlations (r > or = 0.5 or < or =-0.5) were not found between echocardiographic indices and intraoperative circulatory manifestations, but intensive vasopressor coverage, urine output, sodium bicarbonate administration and last blood pH showed potential relations with at least one of preoperative echocardiographic indices. Early and late (atrial) ventricular filling velocity (E/A) ratios were lower in recipients with intensive vasopressor coverage, and left atrial diameter (LAD) were larger in recipients with last blood pH < 7.25. However, other parts of echocardiographic indices showed inconsistent relationships with formerly prevalent knowledge.
Preoperative echocardiographic indices such as E/A ratio and LAD showed relationship with circulatory manifestations during LDLT. However, low correlation degrees and lack of evidence in reverse relationship with circulatory manifestations demands further studies focusing on such specific cardiac function.
Key Words: Circulation, Diastolic dysfunction, Echocardiography, Liver transplantation

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