The Challenging Management of an Intracardiac Thrombus in a Liver Transplant Patient at the Reperfusion Phase: A Case Report and Brief Literature Review

Luigi Vetrugno, MD; Vittorio Cherchi, MD, PhD; Dario Lorenzin, MD, PhD; Francesco De Lorenzo, MD; Marco Ventin, MD; Victor Zanini, MD; Giovanni Terrosu, MD; Andrea Risaliti, MD; Umberto Baccarani, MD, PhD; Tiziana Bove, MD

doi:10.1097/TXD.0000000000001200

Transplantation Direct (Oct 2021)

The Challenging Management of an Intracardiac Thrombus in a Liver Transplant Patient at the Reperfusion Phase: A Case Report and Brief Literature Review

Luigi Vetrugno, MD,
Vittorio Cherchi, MD, PhD,
Dario Lorenzin, MD, PhD,
Francesco De Lorenzo, MD,
Marco Ventin, MD,
Victor Zanini, MD,
Giovanni Terrosu, MD,
Andrea Risaliti, MD,
Umberto Baccarani, MD, PhD,
Tiziana Bove, MD

Affiliations

Luigi Vetrugno, MD: 1 Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.
Vittorio Cherchi, MD, PhD: 3 General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy.
Dario Lorenzin, MD, PhD: 3 General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy.
Francesco De Lorenzo, MD: 1 Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.
Marco Ventin, MD: 2 Department of Medicine, University of Udine, Italy, Udine, Italy.
Victor Zanini, MD: 1 Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.
Giovanni Terrosu, MD: 2 Department of Medicine, University of Udine, Italy, Udine, Italy.
Andrea Risaliti, MD: 2 Department of Medicine, University of Udine, Italy, Udine, Italy.
Umberto Baccarani, MD, PhD: 2 Department of Medicine, University of Udine, Italy, Udine, Italy.
Tiziana Bove, MD: 1 Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.

DOI: https://doi.org/10.1097/TXD.0000000000001200
Journal volume & issue: Vol. 7, no. 10
p. e746

Abstract

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The exact origin of intracardiac thrombi formation during orthotopic liver transplant remains unknown. The altered balance between hypercoagulability, hypocoagulation, and endothelial dysfunction associated with end-stage liver disease is thought to play a pivotal role. Venous stasis, vascular clamping, and reperfusion could also contribute to clot formation. The incidence of intracardiac thrombi formation stands at 4.2%, associated with a mortality rate of 45.5%, and to date, no consensus exists regarding the best way to treat this complication. Intraoperative transesophageal echocardiography is the only effective method for diagnosing intracardiac thrombi formation early, while point-of-care coagulation testing could guide the coagulation management potentially improving patient outcomes.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

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