[Tim Schreuder]

Dear Elisa,

Thanks for your fast reply.
You are completely right regarding her clinical condition. She is in an exceptional good clinical condition. The PAP systolic and diastolic are indeed 43/21 mm Hg. Her pulmonary resistance is 85 dynes.
I’ll have a new discussion with the team.

I’ll keep you posted!

Kind regards, Tim

[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,
Tim

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