{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T16:54:09Z","timestamp":1781628849735,"version":"3.54.5"},"reference-count":6,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Minimally invasive cardiac surgery (MICS) reduces surgical trauma but limits direct visualization of surrounding structures, posing a risk of unrecognized injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 65-year-old man with alcoholic cirrhosis underwent mitral valvuloplasty, tricuspid annuloplasty, and Maze procedure via right mini-thoracotomy. During cardiopulmonary bypass (CPB), progressive reservoir volume loss was noted by a perfusionist. However, no collection of blood was evident in the surgical field, and thus, reservoir volume was maintained with volume transfusion. After weaning from CPB, transesophageal echocardiography (TEE) revealed free fluid around the liver. Exploratory laparoscopy confirmed a 1-cm liver laceration likely caused during a trocar insertion. Hemostasis was achieved surgically, and the patient recovered without complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Iatrogenic liver injury during MICS is rare and may lack intraoperative hemodynamic signs. In this case, timely intraoperative detection of abdominal bleeding using TEE enabled immediate intervention. Routine TEE assessment of intra-abdominal free fluid may help identify similar injuries early and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12871-025-03591-0","type":"journal-article","created":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T18:23:48Z","timestamp":1767119028000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transesophageal echocardiography uncovers iatrogenic liver injury during minimally invasive mitral valve surgery: case report"],"prefix":"10.1186","volume":"26","author":[{"given":"Toshifumi","family":"Yanagi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Hussey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenichi","family":"Ueda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"3591_CR1","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1016\/j.ijcard.2016.08.227","volume":"223","author":"G Dieberg","year":"2016","unstructured":"Dieberg G, Smart NA, King N. Minimally invasive cardiac surgery: a systematic review and meta-analysis. Int J Cardiol. 2016;223:554\u201360.","journal-title":"Int J Cardiol"},{"issue":"4","key":"3591_CR2","doi-asserted-by":"publisher","first-page":"476","DOI":"10.1111\/jocs.12346","volume":"29","author":"PW Hashim","year":"2014","unstructured":"Hashim PW, Hashim SW. Liver laceration from a diaphragmatic suture in minithoracotomy mitral valve repair. J Card Surg. 2014;29(4):476\u20137.","journal-title":"J Card Surg"},{"issue":"3","key":"3591_CR3","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1111\/jocs.14413","volume":"35","author":"J Duan","year":"2020","unstructured":"Duan J, Sun T, Ge S, Zhang C, Liu Z, Gong Q. A case of abdominal bleeding after mitral valvuloplasty assisted by da Vinci robotic surgery. J Card Surg. 2020;35(3):683\u20135.","journal-title":"J Card Surg"},{"issue":"6","key":"3591_CR4","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1093\/icvts\/ivs050","volume":"14","author":"KL Kristensen","year":"2012","unstructured":"Kristensen KL, Rauer LJ, Mortensen PE, Kjeldsen BJ. Reoperation for bleeding in cardiac surgery. Interact Cardiovasc Thorac Surg. 2012;14(6):709\u201313.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"2","key":"3591_CR5","doi-asserted-by":"publisher","first-page":"125","DOI":"10.4103\/0971-9784.129844","volume":"17","author":"V Malik","year":"2014","unstructured":"Malik V, Hote M, Jha A. Minimally invasive cardiac surgery and transesophageal echocardiography. Ann Card Anaesth. 2014;17(2):125.","journal-title":"Ann Card Anaesth"},{"issue":"1","key":"3591_CR6","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1097\/ACO.0000000000000807","volume":"33","author":"ABA Prempeh","year":"2020","unstructured":"Prempeh ABA, Scherman J, Swanevelder JL. Transesophageal echocardiography in minimally invasive cardiac surgery. Curr Opin Anaesthesiol. 2020;33(1):83\u201391.","journal-title":"Curr Opin Anaesthesiol"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12871-025-03591-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03591-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-025-03591-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:59:06Z","timestamp":1781625546000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12871-025-03591-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":6,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3591"],"URL":"https:\/\/doi.org\/10.1186\/s12871-025-03591-0","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]},"assertion":[{"value":"27 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for the publication of this case report, including all clinical data and images, was obtained from the patient in accordance with institutional and ethical guidelines. A copy of the written consent is available for review by the Editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"75"}}