Reddy Rakesh V, Agarwal Sanjay, Choudhary Vinod, Singhal Amit K
Liver Transplant Anesthesia and Critical Care, BLK Superspeciality Hospital, New Delhi, India.
Indian J Anaesth. 2018 Dec;62(12):988-990. doi: 10.4103/ija.IJA_402_18.
A 39-year-old female patient with hepatitis B-related decompensated chronic liver disease underwent living donor liver transplantation. Preoperatively, she had a normal electrocardiogram (ECG) and echocardiography, and also a negative dobutamine stress echocardiography test. Intraoperative course went uneventful. Two hours postoperatively, she developed hypotension. Initially, hypotension was treated with fluids and blood products after confirming normal echocardiography, but with time, patient's haemodynamics worsened. Repeat echocardiography showed postero-inferior regional wall motion abnormality. Troponin I was significantly elevated, but ECG was normal. Suspecting myocardial infarction coronary angiography was done which was normal. Based on Mayo's criteria, patient was diagnosed with reverse Takotsubo cardiomyopathy since postero-inferior wall was involved. Inotropic support failed to maintain haemodynamics and intra-aortic balloon pump (IABP) was placed. Inotropes were gradually tapered and IABP was removed at day 4. Twenty days later, repeat echocardiography was normal and patient was subsequently discharged.
一名患有乙型肝炎相关失代偿性慢性肝病的39岁女性患者接受了活体肝移植。术前，她的心电图（ECG）和超声心动图正常，多巴酚丁胺负荷超声心动图检查也为阴性。手术过程顺利。术后两小时，她出现低血压。最初，在确认超声心动图正常后，通过补液和输注血液制品治疗低血压，但随着时间推移，患者的血流动力学恶化。重复超声心动图显示后下壁节段性室壁运动异常。肌钙蛋白I显著升高，但心电图正常。怀疑心肌梗死，进行了冠状动脉造影，结果正常。根据梅奥标准，由于后下壁受累，患者被诊断为反向Takotsubo心肌病。使用正性肌力药物支持未能维持血流动力学，遂置入主动脉内球囊反搏（IABP）。逐渐减少正性肌力药物的使用，并在第4天移除IABP。20天后，重复超声心动图显示正常，患者随后出院。
