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Reverse Takotsubo cardiomyopathy after orthotopic liver transplantation. A case report

Lucian Mihalcea
Lucian Mihalcea
, 
Isac Sebastian
Isac Sebastian
, 
Mihail Simion-Cotorogea
Mihail Simion-Cotorogea
, 
Artsiom Klimko
Artsiom Klimko
 and 
Gabriela Droc
Gabriela Droc
   | May 12, 2022
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Article Category: Case Report
Published Online: May 12, 2022
Page range: 117 - 122
Received: Dec 20, 2021
Accepted: Mar 19, 2022
DOI: https://doi.org/10.2478/jccm-2022-0002
Keywords
© 2022 Lucian Mihalcea, Isac Sebastian, Mihail Simion-Cotorogea, Artsiom Klimko, Gabriela Droc, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Preoperatively ECG showing flattened T waves in DIII, low voltage waves in limb leads
Preoperatively ECG showing flattened T waves in DIII, low voltage waves in limb leads

Fig. 2

Postoperatively ECG tracing revealing ST-T abnormality in V2-V5 leads.
Postoperatively ECG tracing revealing ST-T abnormality in V2-V5 leads.

Fig. 3

TEE imaging showing hypokinesia of the LV base. No RV motion anomalies were identified.
TEE imaging showing hypokinesia of the LV base. No RV motion anomalies were identified.

Fig. 4

Angiography showing no coronary occlusion
Angiography showing no coronary occlusion

Fig. 5

Postcontrast thoracic CT-scan revealing bilateral pleural effusions. No signs for central thromboembolism or pneumothorax were documented.
Postcontrast thoracic CT-scan revealing bilateral pleural effusions. No signs for central thromboembolism or pneumothorax were documented.

Postoperative hemodynamic parameters.

Postoperative hours +4 +12 +20 +24 +28 +32 +36 +40 +44 +48
CVP (mmHg) 14 16 15 21 22 19 18 18 18 18
CI (l/min/m2) 2.7 2.6 2.4 1.4 1.32 1.34 1.52 1.5 1.55 1.66
SVRI (dynes·sec/cm5/m2) 1790 1800 1900 2700 3505 3670 3400 3160 3250 2950
ELWI (ml/kg) 9.3 8.5 7.9 11.5 13.3 12 14 12 11 10.3
SVV (%) 14 10 11 12 12 13 13 13 12 12
Norepi (mcg/kg/min) 0.1 - - 0.3 1.82 2.08 2.08 2.2 2.4 2.4
Dobutamine (mcg/kg/min) - - - 2.5 5.3 8.33 10.7 10.7 10.7 10.7
BP (mmHg) 112/87 108/83 109/79 103/73 101/71 83/53 92/52 103/61 107/66 99/61

Intraoperative hemodynamic parameters. CVP- central venous pressure, CI-cardiac index, SVRI- systemic vascular resistance index, ELWI-extra lung water index, SVV- stroke volume variation, Norepi- norepinephrine, BP- blood pressure.

Time since induction (min) 0 30 60 * 90 120 150** 180 210 240 270 300 330 360
CVP (mmHg) 14 13 9 8 8 16 15 14 15 14 13 13 14
CI (l/min/m2) 2.9 2.8 2.5 2.5 2.4 2.6 2.7 2.8 2.7 2.7 2.7 2.6 2.6
SVRI (dynes·sec/cm5/m2) 1954 1901 1870 1656 1402 1103 1302 1520 1660 1596 1584 1767 1989
ELWI (ml/kg) 8.9 9.2 10.1 10.1 11 11 10.9 10.6 10.7 10.6 10.8 10.2 10.3
SVV (%) 12 13 13 12 10 18 18 14 14 15 14 13 12
Norepi (mcg/kg/min) 0.04 0.12 0.14 0.36 0.6 1.27 0.82 0.68 0.3 0.33 0.33 0.25 0.15
BP (mmHg) 105/65 100/60 100/63 90/60 90/60 115/70 110/70 115/70 120/70 110/70 105/60 110/65 115/70
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