Perioperative Stress-Induced (Takotsubo) Cardiomyopathy in Liver Transplant Recipients

Abstract

A comprehensive analysis of published cases of Takotsubo cardiomyopathy, occurred in liver transplant recipients in the perioperative period, has been attempted in this review. Predisposing factors, precipitating events, potential physiological mechanisms, acute and post-event management have been discussed.

Fulminant hepatitis A complicated by Takotsubo syndrome successfully treated with standard volume plasma exchange

“…The recovery of cardiac function varied from 3 to 16 days and all these patients survived except for 1 who died of unrelated causes. 8 Finally, Takotsubo syndrome has also been reported in 2 patients with ALF, one of whom required liver transplantation. 3,4 Our case is unique for 2 reasons.…”

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation – Which Came First?

“…Takotsubo syndrome (TS) is a transient, reversible, stressinduced cardiomyopathy. For diagnosis, all 4 of the following Mayo Clinic diagnostic criteria must be met: 1) transient left ventricular systolic dysfunction, 2) absence of obstructive coronary disease or angiographic evidence of acute plaque rupture, 3) new electrocardiographic abnormalities or modest elevation in cardiac troponin, and 4) absence of pheochromocytoma or myocarditis [1,2]. EKG changes can include transient ST-segment elevation, non-specific T-wave abnormalities, or new bundle-branch block [2].…”

“…The new EKG abnormalities and elevated cardiac troponin necessitate inclusion of myocardial infarction in the differential diagnosis [2]. Echocardiograms classically show apical ballooning in TS [1,3]. Physical, physiological, and emotional stress are risk factors that can precipitate TS [1].…”

“…Echocardiograms classically show apical ballooning in TS [1,3]. Physical, physiological, and emotional stress are risk factors that can precipitate TS [1].…”

“…TS has most commonly been reported in elderly women with neurological or psychiatric disorders, but is increasingly being reported in postoperative patients [1,4]. Recently, several case series and retrospective studies have described TS in liver transplantation (LT) patients in the perioperative period [1,5]. In a retrospective, single-center study of 1752 liver transplants, the incidence of TS was found to be 1.4% [6].…”