肝移植后射血分数严重降低的心力衰竭:一例报告和文献复习。

IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Acta Clinica Belgica Pub Date : 2024-02-01 Epub Date: 2024-01-02 DOI:10.1080/17843286.2023.2278240
Dorien Pint, Andreas B Gevaert, Thomas Vanwolleghem, Thiery Chapelle, Karolien Dams
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引用次数: 0

摘要

背景:肝移植(LT)对心血管系统来说是一项艰巨的任务。心血管事件(CVE),包括心力衰竭(HF)、心律失常和心肌缺血,是肝移植前后发病率和死亡率的重要原因。病例介绍:我们描述了一例45岁的男性患者,他在接受肝移植(LT)治疗终末期酒精性肝硬化后,出现射血分数严重降低的心力衰竭。术前经胸超声心动图(TTE)显示临界左心室射血分数(LVEF)为50%,舒张功能障碍为2级。在冠状动脉造影中,患者没有冠状动脉狭窄。术后早期持续需要血管升压药、肌酸酐水平升高和进行性胸腔积液。术后第6天经胸超声心动图显示,左心室射血分数显著降低15%,伴有hs-TnI和CK-MB的离散增加,没有心电图(ECG)ST-T异常。随访期间LVEF未完全恢复(EF为45%)。病人突然死亡4.5 肝移植后数月。结论:我们的病例表明,在正常范围内进行术前静息检查并不能排除LT后收缩功能障碍的风险,并强调了在LT前进行术前心脏压力评估(如多巴酚丁胺超声心动图或压力性心脏磁共振成像)的必要性。此外,肝移植等待名单上有心脏功能障碍的患者应该由一个多学科团队跟进,其中包括一个在管理肝脏相关心脏病理方面经验丰富的专门心脏病学团队。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Heart failure with severely reduced ejection fraction after liver transplantation: a case report and review of the literature.

Background: Liver transplantation (LT) is a strenuous event for the cardiovascular system. Cardiovascular events (CVE), including heart failure (HF), arrhythmias and myocardial ischemia, are important causes of peri- and post-liver transplantation morbidity and mortality.

Case presentation: We describe the case of a 45-year-old male patient who developed heart failure with severely reduced ejection fraction (HFrEF) after receiving liver transplantation (LT) for end-stage post-alcoholic liver cirrhosis. Preoperative transthoracic echocardiography (TTE) demonstrated borderline left ventricular ejection fraction (LVEF) of 50% and diastolic dysfunction grade 2. On coronary angiography, the patient had no coronary stenoses. Persistent vasopressor need, increasing creatinine levels and progressive pleural effusion characterized the early postoperative period. TTE on postoperative day 6 revealed a new finding of a markedly reduced LVEF of 15%, accompanied by a discrete increase in hs-TnI and CK-MB without electrocardiographic (ECG) ST-T abnormalities. LVEF did not recover completely (EF 45%) during follow-up. The patient had a sudden death 4.5 months post-liver transplantation.

Conclusion: Our case demonstrates that the risk of post-LT systolic dysfunction is not excluded by preoperative resting examinations within normal range and highlights the need for preoperative cardiac stress assessment (e.g. dobutamine echocardiography or stress cardiac magnetic resonance imaging) before LT. In addition, patients on a liver-transplant waiting list with cardiac dysfunction should be followed by a multidisciplinary team including a dedicated cardiology team experienced in managing liver-related cardiac pathology.

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来源期刊
Acta Clinica Belgica
Acta Clinica Belgica MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
0.00%
发文量
44
期刊介绍: Acta Clinica Belgica: International Journal of Clinical and Laboratory Medicine primarily publishes papers on clinical medicine, clinical chemistry, pathology and molecular biology, provided they describe results which contribute to our understanding of clinical problems or describe new methods applicable to clinical investigation. Readership includes physicians, pathologists, pharmacists and physicians working in non-academic and academic hospitals, practicing internal medicine and its subspecialties.
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