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Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%

BACKGROUND AND OBJECTIVES: Laparoscopic procedures are becoming increasingly popular, even in the severely ill patient. We present a case of a cardiac transplant candidate with an ejection fraction of less than 15% who underwent a laparoscopic cholecystectomy. This is the first case in which intraop...

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Detalles Bibliográficos
Autores principales: Jones, Perry E., Sayson, Samuel C., Koehler, David C.
Formato: Texto
Lenguaje:English
Publicado: Society of Laparoendoscopic Surgeons 1998
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015268/
https://www.ncbi.nlm.nih.gov/pubmed/9876720
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author Jones, Perry E.
Sayson, Samuel C.
Koehler, David C.
author_facet Jones, Perry E.
Sayson, Samuel C.
Koehler, David C.
author_sort Jones, Perry E.
collection PubMed
description BACKGROUND AND OBJECTIVES: Laparoscopic procedures are becoming increasingly popular, even in the severely ill patient. We present a case of a cardiac transplant candidate with an ejection fraction of less than 15% who underwent a laparoscopic cholecystectomy. This is the first case in which intraoperative hemodynamic measurements were recorded in a patient with cardiopulmonary disease this severe. METHODS: The patient underwent the procedure while measurements were made at crucial intervals (baseline, with incremental insufflation, reverse Trendelenberg, at desufflation) using a pulmonary artery catheter, transesophageal echocardiography with fractional area measurements, radial arterial line, as well as standard monitoring. RESULTS: This patient showed hemodynamic changes consistent with a person without severe heart disease. There was a rise in mean arterial and systemic vascular resistance with insufflation to 10 mm Hg, which was further exaggerated by reverse Trendelenberg. Heart rate and pulmonary artery wedge pressure increased slightly. The cardiac output and fractional area change declined minimally. CONCLUSIONS: We conclude that if a patient with congestive heart failure is medically optimized, and intra-abdominal pressures and surgical times are minimized, laparoscopic cholecystectomy may be performed with minimal risk to the patient.
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spelling pubmed-30152682011-02-17 Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15% Jones, Perry E. Sayson, Samuel C. Koehler, David C. JSLS Case Reports BACKGROUND AND OBJECTIVES: Laparoscopic procedures are becoming increasingly popular, even in the severely ill patient. We present a case of a cardiac transplant candidate with an ejection fraction of less than 15% who underwent a laparoscopic cholecystectomy. This is the first case in which intraoperative hemodynamic measurements were recorded in a patient with cardiopulmonary disease this severe. METHODS: The patient underwent the procedure while measurements were made at crucial intervals (baseline, with incremental insufflation, reverse Trendelenberg, at desufflation) using a pulmonary artery catheter, transesophageal echocardiography with fractional area measurements, radial arterial line, as well as standard monitoring. RESULTS: This patient showed hemodynamic changes consistent with a person without severe heart disease. There was a rise in mean arterial and systemic vascular resistance with insufflation to 10 mm Hg, which was further exaggerated by reverse Trendelenberg. Heart rate and pulmonary artery wedge pressure increased slightly. The cardiac output and fractional area change declined minimally. CONCLUSIONS: We conclude that if a patient with congestive heart failure is medically optimized, and intra-abdominal pressures and surgical times are minimized, laparoscopic cholecystectomy may be performed with minimal risk to the patient. Society of Laparoendoscopic Surgeons 1998 /pmc/articles/PMC3015268/ /pubmed/9876720 Text en © 1998 by JSLS, Journal of the Society of Laparoendoscopic Surgeons. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits for noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited and is not altered in any way.
spellingShingle Case Reports
Jones, Perry E.
Sayson, Samuel C.
Koehler, David C.
Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title_full Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title_fullStr Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title_full_unstemmed Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title_short Laparoscopic Cholecystectomy in a Cardiac Transplant Candidate with an Ejection Fraction of Less than 15%
title_sort laparoscopic cholecystectomy in a cardiac transplant candidate with an ejection fraction of less than 15%
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015268/
https://www.ncbi.nlm.nih.gov/pubmed/9876720
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