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. 2018 Dec;62(12):988-990.
doi: 10.4103/ija.IJA_402_18.

Reverse stress cardiomyopathy post-liver transplant needing mechanical circulatory support

Rakesh V Reddy  1 , Sanjay Agarwal  1 , Vinod Choudhary  1 , Amit K Singhal  1
Affiliations

Reverse stress cardiomyopathy post-liver transplant needing mechanical circulatory support

Rakesh V Reddy et al. Indian J Anaesth. 2018 Dec.

Abstract

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.

Keywords: IABP; LDLT; stress cardiomyopathy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transthoracic echocardiography-parasternal long axis view showing inferior wall hypokinesia
Figure 2
Figure 2
Transthoracic echocardiography-parasternal short axis view showing posterior wall hypokinesia
See this image and copyright information in PMC

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