Abstract
Introduction Takotsubo cardiomyopathy (TC), known as “broken heart syndrome” is a temporary, predominantly left ventricular dysfunction associated with emotional or physical triggers. Brain death (BD) can be a trigger through catecholamine storm and Cushing reflex. In case of heart transplantation (HTX) it can lead to donor heart dysfunction, a common cause of early postoperative mortality. Case Report A 50-year-old woman was listed for HTX following LVAD implantation in 2019 due to advanced heart failure caused by DCMP. In March 2020, a donor heart from a female 28-year-old brain-dead donor with occluding hydrocephalus was offered for her. The donor heart had a reduced EF of 40% with signs of TC with apical hypokinesia. Due to notorious organ shortage in Germany the TC heart was accepted. Following HTX weaning from cardiopulmonary bypass proved to be impossible due to biventricular dysfunction. A peripheral v-a-ECMO was implanted. Due to insufficient left ventricular unloading on v-a-ECMO, 9 hours after HTX, an Impella® 5.5 was implanted. Circulatory function improved and inotropes could be weaned during ICU stay. Improving LV function was documented on regular transesophageal echocardiographies. ST-segment elevations in the ECG were declining as well as CK levels and CK-MB/CK-ratio. V-A-ECMO was explanted 4 days after HTX and Impella® 5.5 explantation was performed the day after. By that time biventricular function had fully recovered. Myocardial biopsies showed no signs of rejection or inflammation. Acute on chronic renal failure made temporary hemodialysis necessary. Due to sternal wound healing complications the postoperative course was prolonged. The patient was discharged after 55 days. Significant stenosis of the coronary arteries was excluded during follow-up. Four months after discharge the patient is doing well and fully engages in everyday life. Summary Takotsubo cardiomyopathy is transient and there is evidence that inotropes play a role in the pathogenesis. Transplantation of such hearts with consecutive early temporary mechanical circulatory support is feasible. Subsequently it might be worth to reconsider criteria for rejection of donor hearts in cases of acutely reduced EF.
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