Transplant Proc. 2011 Sep;43(7):2810-3.

Atrial laceration caused by removal of a transjugular intrahepatic portosystemic shunt necessitates emergent cardiopulmonary bypass during liver transplant: a case report.

Tivener D, Vannucci A, Fagley RE, Doyle M, Shenoy S, Chapman W, Kangrga I.

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Department of Anesthesiology, Washington University in St. Louis - School of Medicine, St. Louis, MO 63110, USA.

Abstract

In situ transjugular intrahepatic portosystemic shunting (TIPS) can complicate liver transplantation. We present a case where an intraoperative attempt to remove a malpositioned TIPS resulted in atrial laceration. Massive transfusion and emergent institution of cardiopulmonary bypass allowed patient resuscitation and completion of surgery. We describe our surgical and anesthesiologic management, and discuss the absence of criteria to predict when TIPS may become adherent to the inferior vena cava or the right atrium and difficult to remove.

PMID:: 21911169; [PubMed - indexed for MEDLINE]

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Atrial laceration caused by removal of a transjugular intrahepatic portosystemic shunt necessitates emergent cardiopulmonary bypass during liver transplant: a case report.

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