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 (), at 5 and 30 minutes after clamping (, ) and 15 minutes after unclamping (). No significant difference between PCWP and LVEDP was found. LVEDP significantly decreased at and compared to (); PCWP showed the same trend. A correlation was found between SV and LVEDP ( , ) as well as CI (, ). Data confirm that intraoperative TEE may be a reliable method for hemodynamic monitoring during major liver resections.