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The Japanese octopus trap – takotsubo.

The Japanese octopus trap – takotsubo.

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Patient: Female, 51 Final Diagnosis: Takotsubo cardiomyopathy Symptoms: - Medication: - Clinical Procedure: - Specialty: Cardiology • Transplantology. Rare disease. Left ventricular apical ballooning syndrome (LVAB), also known as Takotsubo cardiomyopathy, is a cardiac syndrome characterized by transient left ventricular dysfunction in the absence...

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... cardiomyopathy is one of the rare but very dan- gerous adverse cardiac events that have been reported af- ter various major surgeries, including liver transplantation. The disease takes its name from the typical left apical bal- looning observed on the end of the systolic left ventriculo- gram, which has the appearance of a Tako-Tsubo, a term for an ancient device used in Japan to trap octopuses in the sea ( Figure 6). Other names -stress cardiomyopathy, left ventric- ular apical ballooning syndrome, and broken heart syndrome -are used interchangeably. ...

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Citations

... Extreme stress with catecholamine surges is known to potentiate stress cardiomyopathy (SCM) or Takotsubo cardiomyopathy associated with liver transplant has been reported. [1][2][3] We report SCM with severe hypoxemia successfully managed with inhaled nitric oxide and supportive care following living donor liver transplantation. ...
Article
Patients with liver disease can have varied cardiac manifestations including pulmonary arteriovenous dilatation. The stress of surgery associated with catecholamine surges can also potentiate stress-related changes. We report management of hypoxemia in a patient who underwent liver transplantation. Although her preoperative oxygenation (SpO2 97%) measured 2 weeks earlier was normal, she manifested hypoxemia on the day of surgery and cardiovascular failure perioperatively. Postoperative investigations revealed a stress cardiomyopathy. The cause of persistent and refractory hypoxemia was uncertain in the context of normal preoperative tests. However, she responded immediately to inhaled nitric oxide, suggesting a correction of ventilation perfusion dynamics. We wish to highlight a possible role of nitric oxide in postoperative liver transplant patients with refractory hypoxemia of uncertain etiology.
... Organ transplantation is a stressful condition, and several cases of TTC have been reported associated with transplantations such as kidney, liver, and heart. [7][8][9][10] To the best of our knowledge, there are only two reports of cases with TTC associated with LuTx in the literature. [5,11] Michel-Cherqui et al. [11] reported a case of TTC diagnosed before LuTx. ...
Article
Takotusubo cardiomyopathy is an acute, temporary cardiac syndrome which is important for the differential diagnosis of dynamic electrocardiography alterations. Takotsubo cardiomyopathy related to lung transplantation is rather rare in the literature with only two case reports. Our case is the first Takotsubo cardiomyopathy case that manifested in the early period after lung transplantation. In this article, we present a 61-yearold male patient who was performed bilateral sequential lung transplantation for chronic obstructive pulmonary disease. During follow-up, Takotsubo cardiomyopathy was diagnosed, primary graft dysfunction related to cardiomyopathy was observed, and extracorporeal membrane oxygenation was required. ©2018 All right reserved by the Turkish Society of Cardiovascular Surgery.
... This case report describes a patient who developed cardiogenic shock 2 days after liver transplantation through a suggestive stress-induced cardiomyopathy, catecholaminergic or Takotsubo-like syndrome. (6) Both the transplant and the laparotomy for the hemoperitoneum may have triggered this syndrome. ...
... This case shows that the cause of acute heart failure (catecholaminergic), even in the context of liver transplantation, should not be underestimated. In the literature, there are at least three other reports of this syndrome after liver transplantation, (6,8) which occurred with heart failure and cardiogenic shock but was successfully treated with pharmacological management only. A retrospective review of 1,460 transplants in a single medical center detected 17 cases of non-ischemic cardiomyopathy. ...
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We report the case of a female patient, 58 years of age, without known heart disease, who underwent liver transplantation without complications. On the second postoperative day, the patient developed cardiogenic shock secondary to stress-induced cardiomyopathy (Takotsubo-like syndrome). The patient was successfully managed with veno-arterial peripheral extracorporeal membrane oxygenation for 6 days, with complete recovery of cardiac function and of the hepatic graft. Coronary syndrome and acute myocarditis were excluded as the causes of the shock. The use of extracorporeal membrane oxygenation in this scenario is possible and safe, considering its specialized protocols and treatment.
... Apart from their increased age as a factor, the characteristic cardiovascular complications of cirrhosis increase the possibility for development of postoperative cardiac complications. 17 Increased cardiac output after liver transplant and preexisting cirrhotic cardiomyopathy predispose to the development of cardiovascular complications when liver transplant recipients are exposed to the hemodynamic stress in the immediate postoperative period. ...
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Objectives: Takotsubo cardiomyopathy, also known as "broken heart syndrome," "apical ballooning syndrome," and "stress-induced cardiomyopathy," was first des cribed in Japanese patients in 1990 by Sato and colleagues. Takotsubo cardiomyopathy is an increasingly recognized syndrome characterized by transient and reversible systolic dysfunction of the apical and middle segments of the left ventricle. This syndrome resembles acute myocardial infarction in the absence of evident coronary artery occlusion. Although the precise pathophysiology of takotsubo cardiomyopathy is still unknown, it seems that it is associated with excessive sympathetic stimulation, microvascular dysfunction, coronary artery vasospasm, and abnormal myocardial tissue metabolism. Materials and methods: Herein, we sought to recognize and summarize the available literature data on Takotsubo cardiomyopathy regarding solid-organ transplant, in an attempt to provide the demographic and morphologic functional characteristics of patients with Takotsubo cardiomyopathy and related clinical implications. Results and conclusions: Transplant surgeons should maintain a high index of clinical suspicion and never underestimate takotsubo cardiomyopathy as a potential cause of heart failure following solid-organ transplant.
... Takotsubo cardiomyopathy is a special form of cardiomyopathy which is also known as Broken Heart Syndrome, Stress Cardiomyopathy and Transient Apical Ballooning Syndrome. It is described by transient left ventricular dysfunction in the absence of coronary artery disease where the heart will take the shape of a Japanese Octopus fish trap called Tako-tsubo [2,3]. Wall motion abnormality of the Left ventricle apex is generally transient and resolves within few days to several weeks [4]. ...
... Strategies for managing this condition post liver transplant are not clear, however most of the reported cases like our patient responded well to Intravenous diuretics and vasopressor support [16] If these strategies fail, then percutaneous devices for hemodynamic support should be considered [8]. Intraaortic balloon pumps can be used in an acute setting for hypotensive crises and cardiogenic shock to achieve hemodynamic support [2,16,17]. In case of refractory heart failure, LVAD implantation has been used successfully in one case report [8]. ...
... Next, we dichotomized our perioperative cases to severe and nonsevere groups. The severe group was defined as those who received extracorporeal membrane oxygenation or intra-aortic balloon pump or both (17) or who died (3). Since 2 patients who died also had these devices in place, the final number for the severe cases was 18. ...
Takotsubo cardiomyopathy (TCM) is a condition that is characterized as a transient ventricular dysfunction in the absence of obstructive coronary artery disease (CAD) and is usually triggered by an acute medical illness or intense physical or emotional stress. Multiple cases of perioperative TCM (pTCM) have been reported from around the world, but a qualitative analysis of these cases has not yet been done. For this systematic review, we searched PubMed for case reports and case series of pTCM published from 1966 to April 2015 with the objective being to evaluate whether differences in demographics, clinical features and outcomes exist between pTCM and nonperioperative (npTCM), as well as to attempt to identify any predictors of the severe form of pTCM, which requires mechanical circulatory support (MCS) devices or leads to death. A total of 93 articles describing 102 cases were retrieved and reviewed. The findings were compared with the analysis of the International Takotsubo Registry by Templin et al and a systematic review of mainly non-perioperative TCM (npTCM) by Gianni et al. Although we were unable to identify definitive risk factors for pTCM, our review suggests that pTCM appears to occur in younger patients and with a lower likelihood of ST segment elevations and T-wave abnormalities than in npTCM. No demographic or clinical factors were identified that were predictive of more severe outcomes. As TCM in general can be a life-threatening event, it would therefore be prudent to consider pTCM within a differential diagnosis in any patient who decompensates in the perioperative period.
... Initially described 25 years ago, it has been studied extensively, and an International Takotsubo Registry (http://www.takotsubo-registry.com/), a consortium of 26 centers, was established in 2011 in Zurich, Switzerland "to find the pathophysiology, epidemiologic features and clinical course of this important disease." Nevertheless, awareness of the gravity of the clinical presentation of perioperative stress cardiomyopathy is lacking, possibly due to a call for a temporary ban on case report publication on the topic. 1 Particularly puzzling is the paucity of case reports of stress cardiomyopathy in liver transplantation settings, [2][3][4][5][6][7][8] given the hyperdynamic state of circulation and high plasma catecholamine concentration in patients with advanced liver failure. 9,10 The authors present a patient who developed cardiogenic shock secondary to perioperative stress cardiomyopathy, and would like to suggest early consideration of mechanical circulatory support in the treatment of this potentially lethal entity. ...
... 15,24 An extensive literature search of case reports of stress cardiomyopathy in liver transplantation settings revealed a total of 8 reported patients. [2][3][4][5][6][7][8] The details of the diagnostic work-up and management are summarized in Table 1. All but 1 patient received inotropic support in the form of norepinephrine infusion, with or without dobutamine; IABC was implemented in only 2 patients. ...
... Initially described 25 years ago, it has been studied extensively, and an International Takotsubo Registry (http://www.takotsubo-registry.com/), a consortium of 26 centers, was established in 2011 in Zurich, Switzerland "to find the pathophysiology, epidemiologic features and clinical course of this important disease." Nevertheless, awareness of the gravity of the clinical presentation of perioperative stress cardiomyopathy is lacking, possibly due to a call for a temporary ban on case report publication on the topic. 1 Particularly puzzling is the paucity of case reports of stress cardiomyopathy in liver transplantation settings, [2][3][4][5][6][7][8] given the hyperdynamic state of circulation and high plasma catecholamine concentration in patients with advanced liver failure. 9,10 The authors present a patient who developed cardiogenic shock secondary to perioperative stress cardiomyopathy, and would like to suggest early consideration of mechanical circulatory support in the treatment of this potentially lethal entity. ...
... 15,24 An extensive literature search of case reports of stress cardiomyopathy in liver transplantation settings revealed a total of 8 reported patients. [2][3][4][5][6][7][8] The details of the diagnostic work-up and management are summarized in Table 1. All but 1 patient received inotropic support in the form of norepinephrine infusion, with or without dobutamine; IABC was implemented in only 2 patients. ...
... Rodrigues et al. 10 reported a case of TC occurring after an open gastrectomy, and TC was also described as a complication of liver transplant or even of caesarean section. 11,12 TC seems to affect principally women, who represents 89.8% of all cases analyzed in Templin's study. The mean age of patients was 66.8 years. ...
Article
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Background: Takotsubo cardiomyopathy syndrome, commonly occurring in postmenopausal women, is characterized by transient apical systolic dysfunction in absence of coronary lesions. The cardiomyopathy is often observed after intense stressful events such as a major surgical procedure. Methods: A 72-year-old woman symptomatic for dyspnea at rest, chest pain, and peripheral edema successfully underwent surgery for noncoronary sinus aneurysm-right atrium fistula repair. Two days after surgery the patient developed takotsubo syndrome, diagnosed according to the Mayo Clinic criteria. We reviewed the literature on takotsubo cardiomyopathy as a complication of major cardiac surgery procedures. Results: Takotsubo cardiomyopathy is confirmed as a possible early complication of cardiac surgery. Exaggerated sympathetic stimulation may cause massive endogenous catecholamine release. Hypoperfusion during cardiopulmonary bypass, inotropic drugs administration, and postoperative anxiety and pain are all factors generating stress, possible coronary artery spasm and transient cardiomyopathy, clinically simulating acute myocardial infarction. Several clinical features have been described such as acute mitral insufficiency, systolic anterior motion of the anterior mitral valve leaflet, left ventricular outflow tract obstruction, acute cardiac failure, and cardiogenic shock. Intraventricular thrombi and adverse cerebrovascular events may also be possible complications. Rare catastrophic events such as left ventricular free wall rupture and ventricular septal perforation have been also encountered. Conclusions: After cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started.
... 1,2 Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. [3][4][5][6][7][8][9] However, the anesthetic management of patients with a history of takotsubo cardiomyopathy remains unclear, especially in patients undergoing liver transplantation. ...
Article
Takotsubo cardiomyopathy has been described in patients undergoing liver transplantation. However, the ideal anesthetic management of patients with a history of takotsubo cardiomyopathy remains unclear, especially in patients undergoing liver transplantation. We describe the use of dexmedetomidine in a patient with a history of takotsubo cardiomyopathy undergoing living-donor liver transplantation.