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Updated: Aug 1, 2026
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Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
[Acute jugular engorgement in liver transplantation]
R Haussmann1, J Motsch, G Otto
1Klinik für Anästhesiologie, Universität Heidelberg.
Der Anaesthesist
|November 1, 1992
Summary
During liver transplantation, a patient experienced a dangerous rise in central venous pressure due to superior vena cava obstruction. This complication, linked to venous lines and a Denver shunt, highlights critical hemodynamic considerations in complex surgeries.
Area of Science:
- Cardiology
- Hepatology
- Surgical Innovation
Background:
- A 56-year-old patient with chronic liver failure underwent liver transplantation.
- A Denver shunt was placed six months prior to the liver transplant procedure.
Observation:
- During the anhepatic phase, marked jugular engorgement and a central venous pressure of 45 mmHg were observed while fashioning the proximal caval anastomosis.
- These hemodynamic changes resolved upon completion of the venous anastomosis and liver placement.
Findings:
- The central venous pressure elevation was attributed to obstruction of the right atrium and distal superior vena cava during anastomosis.
- Pre-existing narrowing of the superior vena cava, exacerbated by venous lines and the Denver shunt, rendered the patient susceptible to this hemodynamic compromise.
Implications:
- This case underscores the importance of assessing superior vena cava patency in patients with shunts undergoing liver transplantation.
- Careful surgical technique and awareness of potential venous obstruction are crucial for managing hemodynamic stability during liver transplantation.
- The findings suggest that routine interventions like venous lines and shunts can have significant hemodynamic implications in specific surgical contexts.
