[Circulatory support with venoarterial ECMO in a patient with biventricular Takotsubo cardiomyopathy]

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Takotsubo cardiomyopathy (TTC) is characterized by acute, transient ventricular dysfunction, often triggered by emotional or physical stress.
• It typically presents as regional left ventricular systolic dysfunction, but can be biventricular in up to 30% of cases.
• Severe cases may lead to refractory cardiogenic shock, necessitating circulatory assist devices.

Observation:

• A young patient underwent pulmonary valve replacement with a bioprosthetic valve.
• Seven weeks post-surgery, she presented with pericardial effusion and tamponade physiology due to post-pericardiotomy syndrome.
• A pericardial window was performed, during which biventricular Takotsubo cardiomyopathy developed.

Findings:

• The biventricular Takotsubo cardiomyopathy resulted in severe cardiogenic shock.
• This was associated with severe mitral and tricuspid regurgitation.
• The patient was refractory to medical management and intra-aortic balloon pump (IABP) support.

Implications:

• The case underscores the potential for Takotsubo cardiomyopathy to occur in complex surgical settings.
• Venoarterial extracorporeal membrane oxygenation (VA-ECMO) was crucial for hemodynamic support.
• This highlights the importance of considering advanced circulatory support in refractory cardiogenic shock secondary to Takotsubo cardiomyopathy.