The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report

Annette Rebel; Lauren Hampton; Zaki-Udin Hassan; Malay Shah

doi:doi:10.11648/j.js.20210904.21

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The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report

Annette Rebel, Lauren Hampton, Zaki-Udin Hassan, Malay Shah

Published in Journal of Surgery (Volume 9, Issue 4)

Received: 15 July 2021 Accepted: 18 August 2021 Published: 27 August 2021

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Abstract

The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.

Published in	Journal of Surgery (Volume 9, Issue 4)
DOI	10.11648/j.js.20210904.21
Page(s)	204-208
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Liver Transplant, Atrial Septal Defect, Transthoracic Echocardiography, Transesophageal Echocardiography, Pre-liver Transplant Screening, Preoperative Optimization

References

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APA Style

Annette Rebel, Lauren Hampton, Zaki-Udin Hassan, Malay Shah. (2021). The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. Journal of Surgery, 9(4), 204-208. https://doi.org/10.11648/j.js.20210904.21

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ACS Style

Annette Rebel; Lauren Hampton; Zaki-Udin Hassan; Malay Shah. The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. J. Surg. 2021, 9(4), 204-208. doi: 10.11648/j.js.20210904.21

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AMA Style

Annette Rebel, Lauren Hampton, Zaki-Udin Hassan, Malay Shah. The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. J Surg. 2021;9(4):204-208. doi: 10.11648/j.js.20210904.21

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@article{10.11648/j.js.20210904.21,
  author = {Annette Rebel and Lauren Hampton and Zaki-Udin Hassan and Malay Shah},
  title = {The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {204-208},
  doi = {10.11648/j.js.20210904.21},
  url = {https://doi.org/10.11648/j.js.20210904.21},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.21},
  abstract = {The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.},
 year = {2021}
}

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TY  - JOUR
T1  - The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report
AU  - Annette Rebel
AU  - Lauren Hampton
AU  - Zaki-Udin Hassan
AU  - Malay Shah
Y1  - 2021/08/27
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.21
DO  - 10.11648/j.js.20210904.21
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 204
EP  - 208
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.21
AB  - The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.
VL  - 9
IS  - 4
ER  -

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Author Information

Annette Rebel

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
Lauren Hampton

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
Zaki-Udin Hassan

Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA
Malay Shah

Department of Surgery, Division of Abdominal Transplant, University of Kentucky, Lexington, Kentucky, USA

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Plain Text BibTeX RIS

APA Style

Annette Rebel, Lauren Hampton, Zaki-Udin Hassan, Malay Shah. (2021). The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. Journal of Surgery, 9(4), 204-208. https://doi.org/10.11648/j.js.20210904.21

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ACS Style

Annette Rebel; Lauren Hampton; Zaki-Udin Hassan; Malay Shah. The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. J. Surg. 2021, 9(4), 204-208. doi: 10.11648/j.js.20210904.21

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AMA Style

Annette Rebel, Lauren Hampton, Zaki-Udin Hassan, Malay Shah. The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report. J Surg. 2021;9(4):204-208. doi: 10.11648/j.js.20210904.21

Copy | Download

@article{10.11648/j.js.20210904.21,
  author = {Annette Rebel and Lauren Hampton and Zaki-Udin Hassan and Malay Shah},
  title = {The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report},
  journal = {Journal of Surgery},
  volume = {9},
  number = {4},
  pages = {204-208},
  doi = {10.11648/j.js.20210904.21},
  url = {https://doi.org/10.11648/j.js.20210904.21},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20210904.21},
  abstract = {The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - The Intraoperative Finding of a Large Atrial Septum Defect Pre-Liver Transplantation: A Case Report
AU  - Annette Rebel
AU  - Lauren Hampton
AU  - Zaki-Udin Hassan
AU  - Malay Shah
Y1  - 2021/08/27
PY  - 2021
N1  - https://doi.org/10.11648/j.js.20210904.21
DO  - 10.11648/j.js.20210904.21
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 204
EP  - 208
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20210904.21
AB  - The case report discusses a significant discrepancy between the pre-transplant cardiac evaluation and post-induction transesophageal echocardiography, leading to aborting the surgical procedure. The transthoracic echocardiography [TTE] pre-liver transplant indicated only a minor intracardiac shunt, while the post-induction transesophageal echocardiography [TEE] showed a large atrial septal defect with a more significant left to right shunt. The attempt to close the defect with a transcatheter closure device failed and the perioperative care team decided not to proceed with the liver transplantation. Later cardiac evaluation with cardiac magnetic resonance imaging demonstrated a secundum atrial septum defect in the inferior border of the interatrial septum with 43 ml flow difference between systemic and pulmonary circulation. The failure to identify a large atrial septal defect/inferior venosus defect in the preoperative screening process for liver transplantation resulted in failing to optimize the patient pre transplant. Although complications related to large atrial septal defects are rare during liver transplant (paradoxical embolisms, malignant arrhythmias, myocardial infarctions or cerebrovascular complications), they can be potentially fatal. The preoperative cardiac assessment should have included optimization of this congenital defect. The case report discusses implications of atrial septal defects for liver transplant and why the screening process may have missed the defect. The findings of a positive bubble study during the transthoracic echocardiography should not be trivialized and may require further workup.
VL  - 9
IS  - 4
ER  -

Copy | Download