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Right Heart Dysfunction in Liver Transplantation

  • Gabriela Droc
  • Ecaterina Scărlătescu
Chapter

Abstract

The heart and the liver are closely related; there are diseases of the heart affecting the liver (cardiac cirrhosis) and illnesses of the liver that involve the heart and finally disorders implicating both the heart and the liver (hemochromatosis, amyloidosis, alcohol abuse). Involvement of the cardio-pulmonary system in chronic liver disease can manifest as different clinical syndromes implicating the right ventricle: cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary syndrome. These problems complicate the perioperative management and the postoperative evolution of liver transplant patients. Cirrhotic cardiomyopathy is characterized by intrinsic alterations in myocardial function. Even if right ventricle dysfunction is not included in the diagnostic criteria of cirrhotic cardiomyopathy, right ventricular diastolic dysfunction is a frequent finding in patients with chronic liver disease. Hepatopulmonary syndrome is defined as a triad of chronic liver dysfunction, intrapulmonary vasodilatation and hypoxemia that worsens with the erect posture. Portopulmonary hypertension is the association of pulmonary with portal hypertension. It is a rare condition but a life threatening one. Cirrhotic patients will be at higher risk of right heart failure due to pulmonary hypertension as we deal with decreased right ventricular contractility in cirrhotic cardiomyopathy or dilatation of the right ventricle secondary to volume overload. Liver transplantation can ameliorate conditions as cirrhotic cardiomyopathy or hepatopulmonary syndrome but does not really influence portopulmonary hypertension and is contraindicated in the severe form.

Keywords

Cirrhotic cardiomyopathy Hepatopulmonary syndrome Portopulmonary hypertension Liver transplant 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gabriela Droc
    • 1
    • 2
  • Ecaterina Scărlătescu
    • 2
  1. 1.University of Medicine and Pharmacy “Carol Davila”BucharestRomania
  2. 2.Department of Anesthesia and Intensive CareFundeni Clinical InstituteBucharestRomania

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