Left ventricular dysfunction mimicking Takotsubo cardiomyopathy following cardiac surgery

Left ventricular dysfunction with apical ballooning consistent with Takotsubo cardiomyopathy was encountered in a 68-year-old woman at 5 h after an uneventful mitral valve replacement and tricuspid valve repair. Preoperatively, the patient had emotional stress as well as worsening congestive heart failure, which might have contributed to this rare postoperative complication. Following diagnosis by transthoracic echocardiography (TTE), and characteristic findings of apical ballooning and a preserved basal contraction of the left ventricle, intra-aortic balloon pumping (IABP) was initiated to minimize the use of inotropic drugs. The patient was successfully weaned from both the IABP and pharmacological support. Follow up with serial TTE showed a gradual recovery of the left ventricle to normal systolic function. The mechanism of onset and pathophysiology of Takotsubo cardiomyopathy remain unclear, especially in postoperative cardiac surgery patients. Since excessive catecholamine stimulation has been proposed as a possible mechanism of Takotsubo cardiomyopathy, early mechanical circulatory assistance after cardiac surgery is advised to minimize catecholamine use in this rare complication.