Transient left ventricular apical ballooning post-pneumoperitoneum: Takotsubo cardiomyopathy. A case report.
The aim of this study was to describe the clinical features and management of Takotsubo cardiomyopathy manifesting during the intraoperative period in a patient undergoing laparoscopic cholecystectomy.


METHODS
a 29-year-old ASA I female patient was posted for laparoscopic cholecystectomy. A standard general anesthetic technique was followed. Two minutes after the initiation of pneumoperitoneum, the patient developed clinical features of acute myocardial infarction with pulmonary edema. The surgery was postponed and the patient was shifted to the ICU. Echocardiography revealed hypokinesis of the left ventricle apex and anterolateral segment. Coronary angiography revealed normal arteries without any stenosis or obstruction. The patient required vasopressor and inotropic support for 4 days and was discharged on the 8th postoperative day. Repeat echocardiography 4 days later demonstrated complete resolution of regional systolic dysfunction. Transient left ventricular dysfunction is a possible occurrence during non-cardiac surgery. Awareness of this condition is essential as early diagnosis and prompt management can save the patient's life. To our knowledge this represents the first case of pneumoperitoneum-induced Takotsubo cardiomyopathy.
Jayaraman
L
L
Department of Anesthesiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India. lakjayaraman@gmail.com
Sethi
N
N
Sharma
S
S
Gautam
N
N
Sahai
C
C
Sood
J
J
D000328:Adult; D005260:Female; D006801:Humans; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects*; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy