肝移植術中に発症した心内血栓・塞栓症による心停止に対しECMOを導入したが重篤な低酸素脳症となった1症例

Severe Hypoxic-Ischemic Encephalopathy after ECMO for Cardiac Arrest due to Intracardiac Thrombosis or Embolism during Liver Transplantation

要旨

　肝移植術中の心内血栓・塞栓症は0.71-6.25％で発症し，その死亡率は68-82％との報告がある。われわれは肝移植術中に発症した心内血栓・塞栓症による心停止に対し体外式膜型人工肺（extracorporeal membrane oxygenation：ECMO）を導入したが，重篤な低酸素脳症となった症例を経験した。経食道心エコーによる早期発見，早期のECMO導入が重要であり，考察を交え報告する。

　We provide the case details of a patient who experienced intraoperative cardiac arrest due to intracardiac thrombosis during liver transplantation. A 40-year-old woman underwent a deceased-donor liver transplantation for end-stage liver disease. Fifty-seven minutes after the initiation of reperfusion of the grafted liver, severe hypotension caused a sudden cardiac arrest. Transesophageal echocardiography（TEE）revealed an intracardiac thrombosis. Extracorporeal membrane oxygenation（ECMO）was initiated, and spontaneous circulation resumed. However, extensive brain hypoxia was observed post-operatively. In liver transplantation, the applications of TEE and ECMO at an early timepoint should be considered in patients with refractory hemodynamic instability of unknown etiology.