Takotsubo Cardiomyopathy Following Liver Transplantation: A Report of 2 Cases

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Transplantation Proceedings


Purpose: Takotsubo cardiomyopathy, also called apical ballooning syndrome, is characterized by regional left ventricular systolic dysfunction that resembles myocardial infarction in its initial presentation; however, it lacks angiographic evidence of coronary artery disease. We evaluated the incidence of takotsubo cardiomyopathy following liver transplant at a diverse urban transplant program.

Methods: This is a retrospective review of patients transplanted at a single center between 2017 and 2019. Here we report 2 cases of takotsubo cardiomyopathy that developed after liver transplantation.

Results: A 65-year-old woman diagnosed with alcoholic cirrhosis underwent a brain-dead donor liver transplant. The postoperative course was complicated by stroke, pulmonary hypertension, and a left internal jugular thrombus. Six months following transplant, the patient developed takotsubo cardiomyopathy with congestive hepatopathy and died of heart failure complications despite maximal medical care. The second case was a 65-year-old woman with alcoholic cirrhosis admitted for a living donor liver transplant. The postoperative period involved recurrent seizures and elevated troponins with markedly reduced ejection fraction, which were appropriately managed. The patient recovered well with supportive care and was discharged to a rehabilitation facility shortly after.

Conclusion: We present a series of patients with takotsubo cardiomyopathy after liver transplantation. The diagnosis depends on the clinical presentation and findings on electrocardiography, echocardiography, and cardiac enzymes. Our patients met the Mayo Clinic diagnostic criteria and were appropriately managed according to guidelines. Our report highlights the possibility of pulmonary hypertension contributing to the development of takotsubo cardiomyopathy. Additional studies are needed to establish a definite correlation.

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