Successful heart transplantation from a donor with takotsubo syndrome

Abstract

Without a heart transplant, 20% of patients with end-stage heartfailure will die within 6 months. If the patient receives a new heart,however, the estimated median survival time exceeds 10 years [1].Unfortunately, because of the paucity of donors who meet the criteriafortransplantation[2,3],heartsareavailableforonlyasmallpercentageof recipients with refractory heart failure who are eligible for hearttransplantation. Current guidelines stipulate that donor hearts shouldnot have wall motion abnormalities and that ejection fraction shouldbe over 40% [4].Takotsubo syndrome is an acute condition with characteristicreversible regional wall motion abnormalities and decreased ejectionfraction. Takotsubo frequently affects patients with severe somaticdisease [5] and is common in patients with cerebral lesions, includingsubarachnoid hemorrhage [5]. The current guidelines do not mentionwhether patients with brain death and takotsubo could be consideredas organ donors.The process of brain death elicits significant somatic stress and acatecholamine surge [6] Increasing evidence suggests that takotsubosyndrome is caused by direct catecholamine toxicity in predisposedpatients and is therefore probably common in patients with braindeath. Here we present a case in which a heart was successfullytransplanted from a donor with wall motion abnormalities due totakotsubo syndrome.