Hemodynamic Changes during Hepatic Vascular Exclusion: Use of Intraoperative Transesophageal Echocardiography a Case Series

The aim of this clinical observation was to compare intraoperative transesophageal echocardiography (TEE) and pulmonary artery catheterization (PAC) during hepatic vascular exclusion (HEV). Five non-cirrhotic patients to undergo HVE for major liver resection have been observed. Hemodynamic parameters: pulmonary arterial wedge pressure (PCWP), cardiac index (CI), cardiac output (CO), and systemic vascular resistance (SVR) have been monitored by PAC. Left ventricular end-diastolic area (LVEDA), left ventricular end-systolic area (LVESA), left ventricular end-diastolic pressure (LVEDP), cardiac index (CI), cardiac output (CO), and fractional area changes (FAC) have been monitored by TEE. Hemodynamic variables were assessed before clamping (?0), at 5 and 30 minutes after clamping (?1, ?2) and 15 minutes after unclamping (?3). No significant difference between PCWP and LVEDP was found. LVEDP significantly decreased at ?1 and ?2 compared to ?0 (?<0.001); PCWP showed the same trend. A correlation was found between SV and LVEDP (?2=0.755, ?<0.001) as well as CI (?2=0.630, ?<0.001). Data confirm that intraoperative TEE may be a reliable method for hemodynamic monitoring during major liver resections.