[Acute jugular engorgement in liver transplantation]

A 56-year-old patient with chronic liver failure underwent liver transplantation; a Denver shunt had been placed 6 months previously. Following an initially uneventful operative course, during fashioning of the proximal caval anastomosis in the anhepatic phase, the patient developed very marked jugular engorgement. The central venous pressure rose to 45 mmHg and this lasted some 15 min. With the opening of the venous anastomosis and placement of the liver in its anatomical site, the central venous pressure returned to normal values once again. It can be concluded that during fashioning of the anastomosis, both the right atrium and distal superior vena cava were obstructed. While normally not haemodynamically significant, in this case, however, the superior vena cava became more narrow by the routinely placed venous lines and the Denver shunt. This in turn, gave rise to this particular clinical manifestation.