Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation - Which Came First?
- 14 April 2020
- journal article
- research article
- Published by International Scientific Information, Inc. in The American Journal of Case Reports
- Vol. 21, e920263-e920263-6
- https://doi.org/10.12659/AJCR.920263
Abstract
Patient: Male, 66-year-old Final Diagnosis: Hepatic artery thrombosis Symptoms: Abdominal pain . lethargy . tachycardia Medication: - Clinical Procedure: - Specialty: Transplantology Objective: Rare co-existance of disease or pathology Background: Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. Case Report: The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. Conclusions: It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.This publication has 23 references indexed in Scilit:
- Takotsubo cardiomyopathy post liver transplantationCardioVascular Journal of Africa, 2016
- Pre-transplant portal vein thrombosis is an independent risk factor for graft loss due to hepatic artery thrombosis in liver transplant recipientsHPB, 2015
- Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of CardiologyEuropean Journal of Heart Failure, 2015
- Cardiac arrest after liver transplantation in a patient with takotsubo cardiomyopathyBritish Journal of Anaesthesia, 2014
- Stress-Induced Cardiomyopathy (Takotsubo Cardiomyopathy) After Liver Transplantation—Report of Two CasesTransplantation Proceedings, 2012
- Role of Inotropic Agents in the Treatment of Heart FailureCirculation, 2010
- Tako-Tsubo syndrome as a rare cause of cardiac failure in liver transplantationLiver International, 2010
- Sodium Nitroprusside for Advanced Low-Output Heart FailureJournal of the American College of Cardiology, 2008
- Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarctionAmerican Heart Journal, 2008
- Inotropes in the management of acute heart failureCritical Care Medicine, 2008