Rawashdeh Badi, Yaghmour Nisreen, Sulieman Dara, Abuassi Mohammad, Cooper Matthew
Medical College of Wisconsin, Division of Transplant Surgery, Milwaukee, WI.
MercyOne Iowa Heart Center, Des Moines, IA.
Ann Med Surg (Lond). 2024 Apr 3;86(5):2883-2891. doi: 10.1097/MS9.0000000000002026. eCollection 2024 May.
Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy that causes temporary left ventricular wall motion abnormalities and abrupt reversible heart failure. The incidence of perioperative TTS is proportional to the severity of surgical trauma, the duration of the procedure, and the degree of apparent sympathetic activity. A growing number of articles have discussed TTS after a solid organ transplant (SOT), which is one of the circumstances in which physical and emotional stress are at their highest levels. The majority of published cases involved patients who had received an orthotopic liver transplant (OLT). TTS occurred in 0.3-1.7% of liver transplant recipients, but a limited number of cases of TTS in patients who had received kidney, heart, or lung transplants have also been documented. In this study, we analyzed the TTS instances that developed after SOT, highlighting the symptoms and causes as well as the various treatment approaches that were applied. Most TTS cases following OLT and kidney transplant cases occurred in the first week of the surgery. However, the majority of cases occurred years after heart transplantation. Dizziness, dyspnoea, and chest discomfort are the most typical symptoms. Patients may also experience syncope and generalized weakness. In spite of this, the symptoms differ depending on the transplanted organ. Dyspnoea is a common symptom after lung transplants, whereas chest discomfort and dizziness are a common symptom after liver and kidney transplants. Yet, chest pain is not a typical symptom after a heart transplant.
应激性心肌病(TTS)是一种由应激诱发的心肌病,可导致暂时性左心室壁运动异常和急性可逆性心力衰竭。围手术期TTS的发生率与手术创伤的严重程度、手术持续时间以及明显的交感神经活动程度成正比。越来越多的文章讨论了实体器官移植(SOT)后的TTS,这是身体和情绪应激处于最高水平的情况之一。大多数已发表的病例涉及接受原位肝移植(OLT)的患者。TTS在0.3%至1.7%的肝移植受者中发生,但也记录了少数接受肾、心脏或肺移植患者发生TTS的病例。在本研究中,我们分析了SOT后发生的TTS病例,重点关注症状、病因以及所采用的各种治疗方法。大多数OLT后和肾移植后的TTS病例发生在手术的第一周。然而,大多数病例发生在心脏移植数年之后。头晕、呼吸困难和胸部不适是最典型的症状。患者也可能出现晕厥和全身无力。尽管如此,症状因移植器官而异。呼吸困难是肺移植后常见的症状,而胸部不适和头晕是肝移植和肾移植后常见的症状。然而,胸痛不是心脏移植后的典型症状。