Epinephrine-Induced Takotsubo Cardiomyopathy During Laparoscopic Myomectomy: Case Report and Review of the Literature

Laparoscopic myomectomy, a minimally invasive procedure performed for the management of uterine leiomyomas, involves a challenging aspect: excessive local bleeding. Hemorrhage control during laparoscopic myomectomy can be achieved through the use of a wide range of vasoconstrictors, including epinephrine. Epinephrine is frequently used for the control of local bleeding during surgery; however, it has been associated with several complications. In this case report, we present a rare and unique case of stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy (TC), caused by intra-myomal injection of epinephrine during laparoscopic myomectomy. TC is a transient type of cardiomyopathy associated with a reversible regional systolic and diastolic dysfunction of the left ventricle as well as various abnormal wall motions, and is often indistinguishable from myocardial infarction. TC is more prevalent in women than in men and has been linked to supraphysiological levels of plasma catecholamine. Although epinephrine is an effective vasoconstrictor used to control bleeding, it is potentially associated with adverse events that should be thoroughly investigated within the field of gynecology and its application to laparoscopic myomectomy. (C) 2017 AAGL. All rights reserved.