Anesthetic Considerations for Patients With Mitral Stenosis Undergoing Orthotopic Liver Transplant

Justin Mitchell; Amar Alnemer; Selina Deiparine; Erica Stein; Leonid Gorelik

doi:10.7759/cureus.47751

Anesthetic Considerations for Patients With Mitral Stenosis Undergoing Orthotopic Liver Transplant

Cureus. 2023 Oct 26;15(10):e47751. doi: 10.7759/cureus.47751. eCollection 2023 Oct.

Authors

Justin Mitchell¹, Amar Alnemer², Selina Deiparine³, Erica Stein⁴, Leonid Gorelik⁴

Affiliations

¹ Anesthesiology, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, USA.
² Anesthesiology, The Ohio State University College of Medicine, Columbus, USA.
³ Orthopedic Surgery, University of Miami Hospital, Miami, USA.
⁴ Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, USA.

Abstract

A 70-year-old male presented for an orthotopic liver transplant (OLT) with co-existing moderate-severe mitral valve stenosis. The hemodynamic goals of managing mitral stenosis posed a significant additional challenge to this patient's care. Intraoperative transesophageal echocardiography (TEE) was critical in guiding volume status and resuscitation. In addition, the patient's valvulopathy guided our vasoactive medication selection and arrhythmia prevention. In this article, we describe the multidisciplinary discussions regarding preoperative valvular intervention as well as the intraoperative techniques used to preserve cardiac output while avoiding coagulopathy and arrhythmias. We discuss the pathophysiology of valvular disease in the context of liver failure and the guidelines by which this disease process is classified. In addition, we discuss the benefits and limitations of intraoperative TEE in evaluating this unique physiology.

Keywords: anesthesiology; cardiothoracic anesthesia; liver transplant; liver transplant anesthesia; mitral valve stenosis.

Publication types

Case Reports