Takotsubo Syndrome-Induced Cardiogenic Shock in Lung Transplantation: Importance of Early Diagnosis and ECMO Implantation.

Abstract

BACKGROUND Takotsubo syndrome, or stress-induced cardiomyopathy, is a rare but serious condition that mimics myocardial infarction and can cause temporary cardiac dysfunction in the absence of coronary artery disease. General anesthesia can make diagnosis more challenging. Although it has already been described in a context of solid organ transplantation, takotsubo syndrome remains under-reported in lung transplantation, necessitating awareness to avoid diagnostic and management delays. CASE REPORT We report a case of takotsubo syndrome in a 54-year-old woman undergoing pulmonary transplantation for end-stage chronic obstructive pulmonary disease. Preoperative evaluations showed no cardiac pathology. During surgery, she developed severe left ventricular failure with ST-segment elevations and diffuse hypokinesia, leading to cardiogenic shock and multiorgan dysfunction. Delayed diagnosis of takotsubo syndrome and late initiation of veno-arterial extracorporeal membrane oxygenation worsened her condition. Postoperatively, she developed lung abscesses, broncho-cutaneous fistula, and hemorrhagic shock, resulting in a prolonged intensive care unit stay. Two years after the transplant, left ventricular dysfunction was persistent, significantly affecting her quality of life. CONCLUSIONS This case report highlights the importance of awareness of takotsubo syndrome associated with lung transplantation, particularly in at-risk patients. Indeed, early diagnosis and management of this cardiomyopathy are crucial for improving outcomes. Multimodal monitoring, including transesophageal echocardiography and continuous ST-segment monitoring, is essential for timely diagnosis. Although rare, this complex clinical condition should be considered in lung transplant recipients with sudden heart failure to ensure prompt and effective treatment. Further research is needed to understand this stress cardiomyopathy in this specific setting and to develop effective management strategies.