Patients with liver NAC disease can have varied cardiac manifestations including pulmonary arteriovenous dilatation.The stress of surgery associated with catecholamine surges can also potentiate stress-related changes.We report management of hypoxemia in a patient who underwent liver transplantation.Although her preoperative oxygenation (SpO2 97%) measured 2 weeks earlier was normal, she manifested hypoxemia on the day of surgery and cardiovascular failure perioperatively.
Postoperative investigations revealed a stress cardiomyopathy.The cause of persistent and refractory Canteens hypoxemia was uncertain in the context of normal preoperative tests.However, she responded immediately to inhaled nitric oxide, suggesting a correction of ventilation perfusion dynamics.We wish to highlight a possible role of nitric oxide in postoperative liver transplant patients with refractory hypoxemia of uncertain etiology.