• Sonal Sharma, Kunal Karamchandani, Ryan Wilson, Sean Baskin, and Dmitri Bezinover.
• Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine/ Penn State Health Milton S. Hershey Medical Center, 500 University Drive, H187, P.O. Box 850, Hershey, PA, 17033-0850, USA.
• BMC Anesthesiol. 2018 Jul 31; 18 (1): 102.

BackgroundPatients undergoing liver transplantation (LT) can develop acute heart failure (HF) in the postoperative period despite having had a normal cardiac evaluation prior to surgery. End-stage liver disease is often associated with underlying cardiac dysfunction which, while not identified during preoperative testing, manifests itself during or immediately after surgery.Case PresentationWe describe three cases of non-ischemic acute HF developing shortly after LT in patients who had a normal preoperative cardiac evaluation. The challenges associated with both diagnosis and management of acute HF in the setting of a newly implanted graft will be discussed.ConclusionsDiastolic dysfunction, QTc interval prolongation, and an increase in BNP may be predictive of postoperative HF. Current recommendations for preoperative cardiovascular evaluation of transplant candidates does not include studies examining these risk factors and should be revised. Further investigations are necessary to evaluate these findings.

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