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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The surgical results are not satisfactory yet in Japan and only 46% of the patients are free of jaundice 3 years ago. However, we found many presentations which reported jaundice disappearance rate with more than 80% in the last several years. The main cause of death in jaundiced patients with the failed hepatic portoenterostomy was hepatic failure. Other causes of deaths in these patients, including those died within one month after operation, were peritonitis, cardiac and/or renal failure, hemorrhagic tendency and lung edema. The main cause of death in jaundice-free patients was rupture of the esophageal varices. We examined 48 long-term survivors ranging in age from 10 to 33 years. There were 41 cases without and 7 with jaundice. Thirty-seven (77%) of 48 cases were leading their normal lives. Among them, 6 cases were enjoying their lives after overcoming the sequelae, such as portal hypertension. The morbidities of the remaining 11 (23%) long-term survivors were jaundice in 7, portal hypertension in 5, encephalopathy after splenorenal shunt in 1 and so on. The cured states of most cases without jaundice are satisfactory and eventually these former patients can achieve a favorable quality of life.
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PMID:[The present status and problems in the treatment of biliary atresia with special reference to surgical and long-term results]. 258 16

Liver transplantation is a challenging surgical operation performed in recipients with major hemodynamic perturbations related to portal hypertension. The pathophysiologic alterations in portal hypertension include a hyperdynamic circulation and decline in systemic vascular resistance and mean arterial pressure. Cardiac function can also be depressed due to cirrhosis related cardiomyopathy. These cirrhosis related changes often lead to a tenuous state in which organ perfusion is threatened and declines rapidly in the setting of many other insults including blood loss, infection, and use of medications which can cause a decline in blood pressure. This can result in renal failure as well as reduced perfusion of other organs. Additionally, direct consequences of portal hypertension include risk of bleeding from porto-systemic collaterals both in the gastrointestinal tract as well as during abdominal dissection in liver transplantation. In this milieu the management of hemodynamic alterations during liver transplant surgery is a daunting task. Recent approaches have utilized various vasoconstrictor therapies along with judicious use of intravenous fluids to maintain systemic pressures and organ perfusion. Added advantages of this approach include the potential for reducing portal pressure and thus the severity of intra-abdominal hemorrhage during surgery as well as potentially increasing renal blood flow and reducing mesenteric hyperemia. Avoidance of liberal fluid use to maintain systemic pressures also has the advantage of reducing the severity of pulmonary edema and risk of reintubation or prolonged intubation after surgery. Although these approaches utilizing vasoconstrictors are promising, many questions remain. Randomized controlled trials like those performed in the pretransplant population are sparse in the setting of liver transplantation. The optimal vasoconstrictors including combinations and doses have not been defined. Most of the benefits demonstrated thus far have been surrogate outcomes such as reduced transfusion requirement, decreased need for reintubation and improved systemic hemodynamics and reduced portal pressures during surgery. There may be different outcomes of these approaches in patients with varying severities of liver disease. The safety of minimization of fluids, along with vasoconstrictor therapy during liver transplantation has been questioned in patients with higher risk of renal failure including recipients with high MELD scores. Other factors besides disease severity, including organ quality and cold ischemia times, need to be accounted for in future trials. Optimal outcomes including postoperative patient and graft survival, hospital stay and renal function should also be incorporated in future trials of vasoconstrictor therapy during liver transplantation.
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PMID:Vasoconstrictor use in liver transplantation: is there evidence for rational use? 2103 46

Hyperdynamic syndrome is a well-known clinical condition found in patients with cirrhosis and portal hypertension, characterized by increased heart rate and cardiac output, and reduced systemic vascular resistance and arterial blood pressure. The leading cause of hyperdynamic circulation in cirrhotic patients is peripheral and splanchnic vasodilatation, due to an increased production/activity of vasodilator factors and decreased vascular reactivity to vasoconstrictors. The term "cirrhotic cardiomyopathy" describes impaired contractile responsiveness to stress, diastolic dysfunction and electrophysiological abnormalities in patients with cirrhosis without known cardiac disease. Underlying circulatory and cardiac dysfunctions are the main determinant in the development of hepatorenal syndrome in advanced cirrhosis. Moreover, the clinical consequences of cirrhosis-related cardiovascular dysfunction are evident during and after liver transplantation, and after transjugular intrahepatic portosystemic shunt insertion. Cardiovascular complications following these procedures are common, with pulmonary edema being the most common complication. Other complications include overt heart failure, arrhythmia, pulmonary hypertension, pericardial effusion, and cardiac thrombus formation. This review discusses the circulatory and cardiovascular dysfunctions in cirrhosis, examining the pathophysiologic and clinical implications in light of the most recent published literature.
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PMID:Cardiovascular dysfunction in patients with liver cirrhosis. 2560 75