Severe Left Ventricular Outflow Tract Obstruction in Living Donor Liver Transplant: A Case Report

Liver transplant involves major hemodynamic changes due to hypovolemia, altered vascular resistance, and postreperfusion syndrome. Dynamic left ventricular outflow tract obstruction may occur during surgery and cause cardiovascular compromise. Early recognition is crucial to prevent adverse outcomes. A 55-year-old female patient with alcoholic liver disease underwent living donor liver transplant. Preoperative echo-cardiography showed a hyperdynamic left ventricle with preserved systolic function. During surgery, the patient developed hypotension, tachycardia, and desaturation. Transesophageal echocardiography revealed severe mitral regurgitation and turbulent flow consistent with left ventricular outflow tract obstruction. Hemodynamic stability was achieved through vasopressor therapy and volume management. The patient developed pulmonary edema but subsequently recovered and was discharged on day 35. This case demonstrates the importance of intraoperative transesophageal echo-cardiography to identify left ventricular outflow tract obstruction during liver transplant. Dynamic left ventricular outflow tract obstruction should be considered in hemodynamic collapse, and early echocardiographic assessment can guide effective intervention.