The Other Side of the Coin: Secondary Takotsubo Syndrome in Living Donor Liver Transplantation Reversul medaliei: sindrom Takotsubo secundar la donator înrudit pentru transplant hepatic

Abstract Introduction Takotsubo syndrome is an acute reversible heart failure syndrome, and its secondary form occurs in patients already hospitalized for another medical, surgical, obstetric, or psychiatric condition. Takotsubo syndrome is also a complication that occurs in liver transplant recipients. There is little data regarding the management and long-term treatment of these patients; major recommendations are based on expert opinion. Case Presentation We present a case of a 46-year-old female patient, with no significant past medical history, admitted for hepatectomy, being a living hepatic transplant donor for her sister. In the early postoperative period, she developed worsening dyspnea, alongside ECG changes, abnormal cardiac biomarkers, and a significant decrease of the left ventricle systolic function, with a typical “apical ballooning” aspect of the left ventricle determined by the wall motion abnormalities that extend beyond the territory of a single coronary artery. All the clinical and imagistic aspects are highly suggestive of Takotsubo syndrome. She further developed a low cardiac output state and cardiogenic shock, with a recovery of her clinical state days later, being under supportive care, with a later improvement of her symptoms and of the left ventricle systolic function on repeated transthoracic echocardiography. Conclusions Takotsubo syndrome may be a complication occurring in liver transplant recipients, with a rising number of cases published. Secondary Takotsubo syndrome occurring in a living liver donor is in itself a peculiarity due to the fact that such cases are not currently reported in literature. We report this case to raise awareness regarding this possible outcome in living donors for solid organ transplantation.