Orthotopic liver transplantation without bypass in a patient with mitral valve prolapse

Editor—Orthotopic liver transplantations (OLT) withoutbypass are associated with the potential for significant bloodloss, sharply decreasing intravascular volume during anhepaticstage, aggressive overloaded volume on reperfusion, and developedreperfusion syndrome around the time of reperfusion. A featureof mitral valve prolapse (MVP) is mitral regurgitation (MR)which may be exacerbated by increased systemic vascular resistance(SVR), bradycardia or excessive tachycardia, and volume overload.We present a case of a successful OLT without bypass in a patientwith anatomical MVP associated with moderate MR with a historyof end-stage liver disease. We present the anaesthetic problemsand management for this