Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare co-existance of disease or pathology
Lydia A. Luu, Badi Rawashdeh, Nicolas Goldaracena, Avinash Agarwal, Emily K. McCracken, Zeyad T. Sahli, Jose Oberholzer, Shawn J. Pelletier
Department of Surgery, Division of Transplantation, University of Virginia, Charlottesville, VA, USA
Am J Case Rep 2020; 21:e920263
Available online: 2020-02-29
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.
Keywords: Hepatic Artery, Liver Transplantation, takotsubo cardiomyopathy