A Case of Severe Tricuspid Valve Regurgitation in a Patient Undergoing Orthotopic Liver Transplantation: Whether to Proceed, or Not.

• Type of Material: Article
• Authors: Justin Mitchell, Ohio State University; Caroline E. Tybout, Ohio State University; Leonid Gorelik, Ohio State University; Sujatha Bhandary, Emory University; Antolin S. Flores, Ohio State University
• Language: English
• Date: 2022-04-13
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2022, Mitchell et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.24119.
• Title of Journal or Parent Work: Cureus
• Volume: 14
• Keywords: transesophageal echocardiography; right heart failure; tricuspid regurgitation; liver transplantation; graft survival; preoperative evaluation; congestive hepatopathy
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

A 38-year-old male presented for orthotopic liver transplantation complicated by new-onset torrential tricuspid regurgitation before incision. Subclinical volume overload and functional tricuspid regurgitation created a challenging scenario in which the benefits of expeditious transplant were weighed against the risks of allograft congestion and failure. Intraoperative transesophageal echocardiography proved critical in diagnosing severe tricuspid regurgitation and guided clinical decision making. In this article, we describe the intraoperative presentation of acutely elevated right heart pressures and the subsequent management of this patient prior to ultimately successful liver transplantation.