Successful use of methylene blue for severe vasoplegia in a patient with partially-treated portopulmonary hypertension with atrial septal defect undergoing liver transplantation: a case report.

Taiga Ishihara, Gaku Kawamura, Mayuko Nagano, Seiichi Azuma, Kanji Uchida, Taro Kariya

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Article in BMC anesthesiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Taiga IshiharaDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan. torakun302180@gmail.com.

Gaku KawamuraDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan.

Mayuko NaganoDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan.

Seiichi AzumaDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan.

Kanji UchidaDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan.

Taro KariyaDepartment of Anesthesiology and Pain Relief Center, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8654, Japan.

Funding

Japan Society for the Promotion of Science JP21K16019

6 · The paper itself

Abstract

backgroundVasoplegia is a life-threatening intraoperative condition. Methylene blue (MB), a potent inhibitor of nitric oxide (NO) synthase and soluble guanylyl cyclase (sGC), can treat vasoplegia but may antagonize pulmonary arterial hypertension (PAH) drugs that enhance the NO-sGC-cyclic guanosine monophosphate (cGMP) pathway. Although reports on the use of MB for vasoplegia during liver transplantation (LT) have often been published, managing vasoplegia during LT in a patient with cardiopulmonary disease, including portopulmonary hypertension (PoPH) - a subgroup of PAH - with intracardiac shunt, is challenging and has not been reported. CASE PRESENTATION: We report a 57-year-old woman with PoPH, on anti-PAH selexipag with concomitant atrial septal defect (ASD) undergoing deceased donor LT. After portal reperfusion, she developed refractory hypotension, in which mean arterial blood pressure (ABP) was less than 50 mmHg and the cardiac index (CI) was maintained at 5.0 L·min

conclusionMB can be lifesaving for intraoperative vasoplegia even in patients with PoPH on PAH drug therapy with an ASD, though potential drug interactions with anti-PAH drugs warrant caution.

Indexed as

Heart Septal Defects, AtrialHypertension, PortalHypertension, PulmonaryIntraoperative ComplicationsLiver TransplantationMethylene BlueVasoplegiaFemaleHumansMiddle AgedMethylene BlueCase reportLiver transplantationMethylene bluePortopulmonary hypertensionVasoplegia

Identifiers

PMID41354794

DOI10.1186/s12871-025-03544-7

PMCPMC12798124

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