Intraoperative Left Ventricular Apical Ballooning: Transient Takotsubo Cardiomyopathy During Orthotopic Liver Transplantation

Abstract

TRANSIENT LEFT VENTRICULAR (LV) apical ballooning, also referred to as “takotsubo syndrome,” is a stress-induced, reversible cardiomyopathy. The syndrome is characterized by transient LV apical and midsystolic dysfunction with basal hyperkinesis. The affected heart, when viewed by echocardiography or catheterization, mimics a shape described as a round-bottomed narrow-necked Japanese fishing pot used to trap octopus, which in Japanese is called “takotsubo.” 1 Bybee K.A. Kara T. Prasad A. et al. Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141: 858-865 Crossref PubMed Scopus (1218) Google Scholar The takotsubo syndrome was first described in the Japanese literature in 1990 and has since been characterized by transient LV apical ballooning in the absence of significant angiographic coronary artery stenosis and cardiomyopathy. 1 Bybee K.A. Kara T. Prasad A. et al. Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141: 858-865 Crossref PubMed Scopus (1218) Google Scholar , 2 Dote K. Sato H. Tateishi H. et al. Myocardial stunning due to simultaneous multivessel coronary spasms: A review of 5 cases. J Cardiol. 1991; 21: 203-214 PubMed Google Scholar In this article, the first case of takotsubo cardiomyopathy under general anesthesia in the United States is reported. 1 Bybee K.A. Kara T. Prasad A. et al. Systematic review: Transient left ventricular apical ballooning: A syndrome that mimics ST-segment elevation myocardial infarction. Ann Intern Med. 2004; 141: 858-865 Crossref PubMed Scopus (1218) Google Scholar , 3 Takigawa T. Tokioka H. Chikai T. et al. A case of undiagnosed “takotsubo” cardiomyopathy during anesthesia. Masui. 2003; 52: 1104-1106 PubMed Google Scholar , 4 Jabaudon M. Bonnin M. Bolandard F. et al. Takotsubo syndrome during induction of general anesthesia. Anaesthesia. 2007; 62: 519-523 Crossref PubMed Scopus (45) Google Scholar , 5 Ramakrishna G. Ravi B.S. Chandrasekaran K. Apical ballooning syndrome in a postoperative patient with normal microvascular perfusion by myocardial contrast echocardiography. Echocardiography. 2005; 22: 606-610 Crossref PubMed Scopus (25) Google Scholar , 6 Gavish D. Rozenman Y. Hafner R. et al. Takotsubo cardiomyopathy after general anesthesia for eye surgery. Anesthesiology. 2006; 105: 621-623 Crossref PubMed Scopus (40) Google Scholar This case report describes the intraoperative and postoperative events leading to the diagnosis of takotsubo cardiomyopathy. In addition, the diagnostic criteria and therapeutic modalities in the management of this acutely life-threatening cardiomyopathy are outlined. Takotsubo Cardiomyopathy in a Liver Transplant Recipient: A Diagnosis of Exclusion?Journal of Cardiothoracic and Vascular AnesthesiaVol. 23Issue 2PreviewTiwari and D'Attellis1 recently reported on transient takotsubo cardiomyopathy (TCM) during liver transplantation (LT). This was only the second case of this type of ventricular dysfunction ever reported in a LT recipient. The first such reported complication occurred several hours after LT.2 In 1 case, major complications triggered the event and in the other it developed spontaneously. In both cases, myocardial infarction was assumed; both patients underwent coronary arterial angiography, which excluded coronary artery disease as a cause in both cases. Full-Text PDF