Mihalcea Lucian, Sebastian Isac, Simion-Cotorogea Mihail, Klimko Artsiom, Droc Gabriela
Department of Anesthesiology and Intensive Care I, Fundeni Clinical Institute, Bucharest, Romania.
Carol Davila University of Medicine and Pharmacy Faculty of Pharmacy, Bucharest, Romania.
J Crit Care Med (Targu Mures). 2022 May 12;8(2):117-122. doi: 10.2478/jccm-2022-0002. eCollection 2022 Apr.
Takotsubo cardiomyopathy is a rare reversible type of heart failure, often precipitated by emotional stress; other risk factors include intracranial bleeding, ischemic stroke, sepsis, major surgery, pheochromocytoma. The clinical, electrical and blood sample analysis features resemble those of a myocardial infarction- however, they occur in the absence of angiographic coronary filling defects.
A 61-year-old male patient, 71 kg, 175 cm, underwent liver transplantation for Child-Pugh B cirrhosis secondary to mixed viral hepatitis (B and D). His medical records revealed mild mitral, aortic, and tricuspid insufficiencies and heart failure with preserved ejection fraction. An initially uneventful perioperative stage was succeeded by cardiogenic shock (cardiac index - 1.2 l/min/ sqm), which the patient developed 24 hours after the intervention. Elevated cardiac markers and ECG abnormalities showing ST-T changes in the V2-V5 leads were additionally noted. Transesophageal echocardiography (TEE) revealed an acute onset reduction in the left ventricular systolic function secondary to basal hypokinesia. No coronary obstruction was detected by percutaneous angiography. The above findings lead to the diagnosis of reverseTakotsubo cardiomyopathy. Further, the patient developed acute kidney injury and liver graft failure, succumbing within 48 hours after the surgical procedure.
We report a rare case of reverse Takotsubo cardiomyopathy in a male patient after orthotopic liver transplant.
应激性心肌病是一种罕见的可逆性心力衰竭类型，常由情绪应激诱发；其他危险因素包括颅内出血、缺血性中风、败血症、大手术、嗜铬细胞瘤。其临床、电生理和血液样本分析特征与心肌梗死相似——然而，这些情况发生时并无血管造影显示的冠状动脉充盈缺损。
一名61岁男性患者，体重71千克，身高175厘米，因混合性病毒性肝炎（B型和D型）继发Child-Pugh B级肝硬化接受肝移植手术。他的病历显示有轻度二尖瓣、主动脉瓣和三尖瓣关闭不全以及射血分数保留的心力衰竭。围手术期最初情况平稳，但术后24小时患者出现心源性休克（心脏指数 - 1.2升/分钟/平方米）。此外还注意到心脏标志物升高以及心电图异常，表现为V2 - V5导联ST - T改变。经食管超声心动图（TEE）显示由于基底运动减弱导致左心室收缩功能急性下降。经皮血管造影未检测到冠状动脉阻塞。上述发现导致诊断为反转型应激性心肌病。此外，患者还出现急性肾损伤和肝移植失败，在手术后48小时内死亡。
我们报告了一例原位肝移植术后男性患者发生反转型应激性心肌病的罕见病例。
