Takotsubo Cardiomyopathy After Cardiac Surgery: A Hidden Menace

Takotsubo cardiomyopathy (TTC) is an episode of transient left ventricular (LV) dysfunction affecting 2.1% of patients with suspected acute ST-segment elevation myocardial infarction.

A 61-year-old woman underwent elective aortic valve replacement for severe aortic regurgitation. An entry tear at the aortic cannulation site necessitated hemiarch replacement. On postoperative day 3, the patient presented with cardiogenic shock, displaying deteriorating LV function with global hypokinesia. Coronary angiography revealed minimal coronary artery disease, whereas computed tomography revealed LV apical ballooning. Extracorporeal membrane oxygenation support was initiated. Echocardiography and computed tomography showed normalization of LV function and resolution of apical ballooning 2 weeks later, permitting extracorporeal membrane oxygenation weaning. The patient was discharged in good health 1 month postoperatively.

Cardiac surgery complicated by TTC is rarely described. This case highlights prolonged cardiopulmonary bypass time and surgical stress as potential TTC triggers.

Clinicians should be mindful of TTC risk after cardiac surgery.