Reply To: Help in patient case

Home Forums website Help in patient case Reply To: Help in patient case

Tim Schreuder

Dear all,

Hereby I would like to have additional advice on this case I presented previous. Since then she has been in a stable clinical condition. I would like to provide questions raised by Elisabetta Buscarini.
– Patient can be classified as NYHA Class II
– Patient hasn’t been suffering from atrial fibrillation, right-sided catheterization in July
revealed CO 10.3 L/min, PAP 43/21 mm Hg, wedge 16 mm Hg and caval vein saturation infrahepatic 88%
and suprahepatic 69%, thoracic and abdominal CT demonstrates no other collaterals besides those in
the liver
– Her liver enzymes are completely normal including bilirubin and INR, hemoglobin is 6.1 mmol/l

After having an extensive look at our EASL guideline and discussions with transplant surgeons and anesthesiologists I got somewhat stuck in how to proceed. Do you think I should persuade the transplant team to have her on the waiting list for transplantation (of course if pulmonary pressures are acceptable and if not bevacizumab used as a bridge to transplantation)? Or do I have to follow a wait-and-see approach with regular cardiology check-ups?
I would be more than happy if one of you could help me out.

Kind regards,