Unexpected refractory intra-operative hypotension during non
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Case :
A 48-year-old, dialysis dependent male (ASA physical status III, body weight 82 kg) with polycystic kidney and liver disease and post bilateral nephrectomies status presented with persistent massive ascites, mild pericardial and bilateral pleural effusions. His ascites and effusions were secondary to a combination of obstruction of hepatic venous outflow and compression of the right heart by cysts in the liver and chronic renal failure. He was scheduled for a debulking liver resection and deroofing of cysts to relieve compression. Other pertinent medical history included diabetes and hypertension. He was also on the waiting list for a combined liver and kidney transplant. His pre-transplant cardiac workup included a trans-thoracic echocardiography (TTE) that showed mild left ventricular dysfunction (EF 45-50%), normal right ventricular function, mild pericardial effusion, no LVOT gradient and no valvular or wall motion abnormalities. Nuclear myocardial perfusion scan demonstrated a small reversible septal defect consistent with myocardial ischemia and a follow-up coronary angiography showed normal coronary circulation......

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3968653/
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