摘要
BACKGROUND Preoperative conditions in pediatric liver transplant recipients are understandably complex.Compared with adults,children have lesser compensatory abilities and demand greater precision during procedural executions.In the setting of endstage liver disease,the heightened perioperative risk of coexistent cardiovascular pathology may impact graft survival as well.Requirements for anesthesia and perioperative management are thus more rigorous,calling for individualized treatments that reflect specific cardiovascular constraints and proposed surgical plans.CASE SUMMARY Reports of perioperative anesthesia management and liver transplant prognostication in pediatric patients with concurrent atrial septal defects are scarce.Herein,we detail the course of liver transplantation in a child with dual afflictions,focusing on perioperative anesthesia management and the important contributions of the anesthesiologist(pre-and perioperatively) to a positive therapeutic outcome,despite the clinical hurdles imposed.CONCLUSION Children with atrial septal defects bear substantially more than customary perioperative risk during orthotopic liver transplants,given their compromised cardiopulmonary reserves and functional states.Comprehensive preoperative cardiovascular assessments,including use of agitated-saline contrast echocardiography(to characterize intracardiac shunting) and multidisciplinary deliberation,may offer insights into structural cardiac pathophysiologic effects and transplantrelated hemodynamic changes that impact new grafts.At the same time,active and effective monitoring and other measures should be taken to maintain hemodynamic stability in the perioperative period,avoid entry of bubbles into the circulation,and ease congestion in newly grafted livers.Such efforts are crucial for transplantation success and graft survival.
基金
Supported by Natural Science Foundation of Zhejiang Province,No. LQ19C090006。
