59-year-old patient, candidate for liver transplantation.
He presented a hepatorenal syndrome that caused an important contribution of volume and furosemide, without obtaining diuretic response.
A donor was found 24 hours later.
At that time, the patient was breathy, with little response to verbal stimuli, BP 110/60, HR 115 per minute, respiratory rate 35x'.
A surface echocardiogram showed good global ventricular function, dilatation of the four cavities and pulmonary artery systolic pressure (PASP) of 50 mmHg.
In the operating room, a TEE and PAC probe was installed and showed a CVP of 25 mmHg, PCP 26 mm Hg, RVSI of 987 dinas*second/cm5/m2.
The CI and PASP measured by CAP and TEE were respectively 4.7 and 5.3 1/ m2, and 49/32 and 48.
The end-diastolic volume of the indexed left ventricle (VFDVII) was 98 ml/m2 (normal value: 35-75 ml/m2).
Fluids were given very restrictedly throughout the procedure good agreement between CI and PASP values measured with PAC and TEE.
At the end of surgery CVP was 14 mmHg, CPP 19 mmHg, PAP 33/22 and CI 5.1/m2.
The TEE showed a PSAP of 32, CI of 5 1/m2, and VFDVI67ml/m2.
