Faculty Collaboration Database

Hepatic Artery Thrombosis and Takotsubo Syndrome After Liver Transplantation - Which Came First? Am J Case Rep 2020 Apr 14;21:e920263

Date

04/15/2020

Pubmed ID

32287173

Pubmed Central ID

PMC7176589

DOI

10.12659/AJCR.920263

Scopus ID

2-s2.0-85083410996 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND Takotsubo syndrome is a transient, reversible, stress-induced cardiomyopathy that affects only 1.4% of liver transplant patients and can cause complications, including cardiogenic shock, arrhythmia, and thromboembolism. Hepatic artery thrombosis is also rare, affecting just 2-4% of these patients, but can have disastrous consequences. Here, we describe a case of concurrent takotsubo syndrome and hepatic artery thrombosis in a postoperative liver transplant recipient. CASE REPORT The patient was a 66-year-old man who underwent living donor liver transplantation for non-alcoholic steatohepatitis. On postoperative day 3, he became lethargic and tachycardic to the 120 s. Work-up, including EKG, troponin I, BNP, and transthoracic echocardiogram, was characteristic for takotsubo syndrome. His LVEF of 15-20% was markedly reduced compared to his baseline of 50-55% from 6 months prior. Hepatic ultrasonography showed no hepatic arterial flow, prompting emergent return to the OR, where intraoperative evaluation revealed hepatic artery thrombosis. The graft was salvaged after hepatic artery thrombectomy and arterial anastomosis revision. We are unable to determine which event caused the other in this case, as both takotsubo syndrome and hepatic artery thrombosis manifested within the same time frame. CONCLUSIONS It is important to recognize takotsubo syndrome as a potential cause of cardiac dysfunction and hepatic artery thrombosis in liver transplant patients, and also be aware that hepatic artery thrombosis can precipitate takotsubo syndrome.

Author List

Luu LA, Rawashdeh B, Goldaracena N, Agarwal A, McCracken EK, Sahli ZT, Oberholzer J, Pelletier SJ

Author

Badi Rawashdeh MBBS Instructor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Hepatic Artery
Humans
Liver Transplantation
Living Donors
Male
Non-alcoholic Fatty Liver Disease
Takotsubo Cardiomyopathy
Thrombectomy
Thrombosis
Ultrasonography