Intraoperative left ventricular apical ballooning: Transient takotsubo cardiomyopathy during orthotopic liver transplantation

TRANSIENT LEFT VENTRICULAR (LV) apical ballooning, also referred to as "takotsubo syndrome," is a stress-induced, reversible cardiomyopathy. The syndrome is characterized by transient LV apical and midsystolic dysfunction with basal hyperkinesis. The affected heart, when viewed by echocardiography or catheterization, mimics a shape described as a round-bottomed narrow-necked Japanese fishing pot used to trap octopus, which in Japanese is called "takotsubo."(1) The takotsubo syndrome was first described in the Japanese literature in 1990 and has since been characterized by transient LV apical ballooning in the absence of significant angiographic coronary artery stenosis and cardiomyopathy.(1-2) In this article, the first case of takotsubo cardiomyopathy under general anesthesia in the United States is reported.(1,3-6) This case report describes the intraoperative and postoperative events leading to the diagnosis of takotsubo cardiomyopathy. In addition, the diagnostic criteria and therapeutic modalities in the management of this acutely life-threatening cardiomyopathy are outlined.