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Farjoud Kouhanjani M, Hosseini SA, Mousavi SM, Noroozi Z, Sadeghi P, Jokar-Derisi A, Jamshidi Mouselou MS, Ahmadi M, Attar A. Takotsubo Cardiomyopathy and Autoimmune Disorders: A Systematic Scoping Review of Published Cases. Int J Clin Pract 2024; 2024:7259200. [PMID: 38414580 PMCID: PMC10898954 DOI: 10.1155/2024/7259200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Takotsubo cardiomyopathy (TCM) features transient left ventricular apical dysfunction or ballooning. The underlying mechanism remains elusive; however, evidence suggests the role of different physical and psychological stressors. We systematically reviewed patients presenting with TCM and autoimmunity to explore the link between the two conditions. Methods We applied the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) to report this review. Using keywords related to autoimmune/immune-mediated diseases and TCM, we searched PubMed, Scopus, and WOS in March 2022. The final results were added to a data extraction sheet. Data were analyzed by SPSS version 26.0. Results Our search yielded 121 studies, including 155 patients. Females were considerably predominant. Most patients had a history of autoimmune disease, and almost a third had a history of cardiovascular disease. Dyspnea and chest pain were the most common chief complaints. More than 70% of patients had experienced physical stress. Myasthenia gravis, systemic lupus erythematosus, and multiple sclerosis were the most frequently reported autoimmune diseases. Conclusion There were similarities in age and sex compared to classic TCM. TCM should be considered as a differential diagnosis for ACS, especially in patients with a positive background of autoimmunity. A precise reporting system is required for further studies.
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Affiliation(s)
- Mohsen Farjoud Kouhanjani
- Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Zahra Noroozi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Paniz Sadeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armita Jokar-Derisi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Meysam Ahmadi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Armin Attar
- Department of Cardiology, School of Medicine, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Vannucci A, Kurian D, Kacha A, Johnson B, Dhawan R. Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation. J Cardiothorac Vasc Anesth 2023; 37:650-653. [PMID: 36609076 DOI: 10.1053/j.jvca.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Andrea Vannucci
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Dinesh Kurian
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Aalok Kacha
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Blaine Johnson
- University of Chicago Medicine, Perfusion Services, Chicago, IL
| | - Richa Dhawan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
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Bachayev M, Brereton B, Mondal A, Alli-Ramsaroop BA, Dhakal R, Leon MCB, Quinones CM, Abdelal MEO, Jain A, Dhaduk K, Desai R. Takotsubo Syndrome in Orthotopic Liver Transplant: A Systematic Review and Pooled Analysis of Published Studies and Case Reports. Transplant Proc 2023:S0041-1345(22)00778-3. [PMID: 36858907 DOI: 10.1016/j.transproceed.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/05/2022] [Accepted: 11/16/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Takotsubo syndrome (TTS) has been reported in solid-organ transplant recipients. However, the pooled data regarding TTS after liver transplant remain limited. METHODS A systematic review was performed through February 2022 using PubMed, Embase, Scopus, and Google Scholar to review case reports/series and original studies on liver transplant-associated TTS. Descriptive analysis was performed for case reports and pooled analysis for the prevalence using random effects models. RESULTS A total of 56 case reports were included from 30 articles (51.8 % male; mean age, 53 years; India 56%, US 27%, and Europe 8.93%) and 10 original studies (US 88.65%, India 10.92%) revealing liver transplant-associated TTS. The pooled prevalence of TTS was 1.1% (95% Cl, 0.6%-1.7%) of all liver transplants with comparable rates in studies from India and the US (P = .92). Indications for liver transplant included end-stage liver disease due to alcohol-related cirrhosis (25%), hepatitis C virus infection (17.9%), hepatocellular carcinoma (10.7%), and non-alcohol-related steatohepatitis (8.9%); the average Model for End-Stage Liver Disease score was 24.75. TTS commonly presented as hypotension (30%), dyspnea (14%), and oliguria, occurring mostly post-transplant (82%), whereas 14% were intraoperative. Common electrocardiogram findings were ST changes, ventricular tachycardia, and atrial fibrillation. Common echocardiogram findings showed left ventricular apical ballooning in 46.5% of cases and reduced ejection fraction < 20% in 41.9% of cases. Common complications were cardiogenic shock (32.1 %), acute kidney injury (12.5%), arrhythmia, stroke, cardiac arrest, and hepatic artery thrombosis. Mechanical circulatory support was required in 30.3%. Recurrence was reported in 15, and mortality in 30.4% of patients. CONCLUSIONS Takotsubo syndrome prevalence after liver transplant is significantly higher than TTS prevalence in general US hospitalizations with potentially worse outcomes. Prospective registries reporting TTS in liver transplant recipients are warranted.
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Affiliation(s)
- Milana Bachayev
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Brian Brereton
- Department of Medicine, Jersey General Hospital, Saint Helier, Jersey
| | - Avilash Mondal
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, Pennsylvania
| | | | - Roshan Dhakal
- Department of Medicine, Nepal Medical College, Kathmandu, Nepal
| | - Maria C Buhl Leon
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Camila M Quinones
- Department of Medicine, Universidad de San Martin de Porres, Lima, Peru
| | - Mohamed Eyad O Abdelal
- Department of Medicine, International University of the Health Sciences, St. Kitts, Nevis
| | - Akhil Jain
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Kartik Dhaduk
- Department of Internal Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, Pennsylvania.
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Kartha A, Sawant A, Kesavan R, Kumar L. Hypoxemia with stress cardiomyopathy following liver transplant: Is there a role for nitric oxide? - A case report. INDIAN JOURNAL OF TRANSPLANTATION 2021. [DOI: 10.4103/ijot.ijot_52_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tanaka A, Onoe T, Ishiyama K, Ide K, Tashiro H, Ohdan H. A rare case of transient left ventricular apical ballooning syndrome following living donor liver transplantation: A case report and literature review. Int J Surg Case Rep 2019; 55:218-222. [PMID: 30771626 PMCID: PMC6376158 DOI: 10.1016/j.ijscr.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/04/2019] [Indexed: 11/29/2022] Open
Abstract
Transient Left Ventricular Apical Balloon Syndrome (LV-ABS) is an acute dysfunction of the left ventricle. Its clinical feature is similar to myocardial infarction. The echocardiogram show characteristic finding which is different from that of myocardial infarction. LV-ABS is rare, however, should be considered after liver transplantation. Proper diagnosis is important to restore cardiac function although it improve almost normally with conservative treatment.
Introduction Transient Left Ventricular Apical Balloon Syndrome (LV-ABS) is an unknown acute dysfunction of the left ventricle, which develops under emotional or physical stress events like the major surgical postoperative period. Presentation of case A 68-year-old woman diagnosed with hepatitis C cirrhosis was admitted for living donor liver transplantation (LDLT). No evidence for underlying cardiac or pulmonary disease was found. LDLT was performed, and her intra and post-operative course was uneventful. On post-operative day 4, dyspnea and tachycardia were observed. Echocardiography showed a severe wall motion abnormality with ballooning of the apex with normal basilar wall motion and a severely impaired left ventricular function with an ejection fraction (EF) of 40%. Blood tests showed greatly increased level of N-terminal pro-brain natriuretic peptide (NT- pro BNP). Evidence of significant ischemic heart disease was not obtained and a transient LV-ABS was diagnosed. Although she required intensive care, her cardiac function became normal by conservative treatment. Discussion Transient LV-ABS has been reported to occur more frequently in post-menopausal women with reduced estrogens reported to protect myocardium from sympathetic stress after mental or physical stress events. It has been suggested that this disease arises from myocardial stunning with high levels of circulating catecholamines and stress related neuropeptides. However, even in a serious condition, cardiac function has recovered normally in all cases by appropriate care. Conclusion Transient LV-ABS is one cause of cardiac dysfunction after LDLT, and it is important to strictly manage cardiac function when diagnosed as transient LV-ABS.
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Affiliation(s)
- Asuka Tanaka
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Takashi Onoe
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Kure, Japan.
| | - Kohei Ishiyama
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Kure, Japan.
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Hirotaka Tashiro
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Kure, Japan.
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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An uncommon cause for grade 3 primary graft dysfunction after lung transplantation: Takotsubo cardiomyopathy. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:487-491. [PMID: 32082786 DOI: 10.5606/tgkdc.dergisi.2018.14905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/29/2017] [Indexed: 11/21/2022]
Abstract
Takotusubo cardiomyopathy is an acute, temporary cardiac syndrome which is important for the differential diagnosis of dynamic electrocardiography alterations. Takotsubo cardiomyopathy related to lung transplantation is rather rare in the literature with only two case reports. Our case is the first Takotsubo cardiomyopathy case that manifested in the early period after lung transplantation. In this article, we present a 61-yearold male patient who was performed bilateral sequential lung transplantation for chronic obstructive pulmonary disease. During follow-up, Takotsubo cardiomyopathy was diagnosed, primary graft dysfunction related to cardiomyopathy was observed, and extracorporeal membrane oxygenation was required.
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Takotsubo Cardiomyopathy Resulting in Cardiac Arrest in a Patient Undergoing Liver Transplantation. Transplant Proc 2018; 49:2392-2394. [PMID: 29198687 DOI: 10.1016/j.transproceed.2017.09.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/04/2017] [Accepted: 09/01/2017] [Indexed: 01/01/2023]
Abstract
Cardiac complications during and after liver transplantation are a common cause of death. Although considered to be uncommon, takotsubo cardiomyopathy, which is characterized by reversible left ventricular akinesis without coronary artery obstruction, is becoming increasingly reported. Herein we have presented a case of reversible stress-induced takotsubo cardiomyopathy resulting in cardiac arrest in a patient undergoing liver transplantation.
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Biondi RS, Barzilai VS, Watanabe ALC, Ferreira GDSA, Atik FA. Use of extracorporeal membrane oxygenation for treating acute cardiomyopathy after liver transplantation: a case report. Rev Bras Ter Intensiva 2018; 30:233-236. [PMID: 29995090 PMCID: PMC6031418 DOI: 10.5935/0103-507x.20180029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/09/2017] [Indexed: 02/05/2023] Open
Abstract
We report the case of a female patient, 58 years of age, without known heart disease, who underwent liver transplantation without complications. On the second postoperative day, the patient developed cardiogenic shock secondary to stress-induced cardiomyopathy (Takotsubo-like syndrome). The patient was successfully managed with veno-arterial peripheral extracorporeal membrane oxygenation for 6 days, with complete recovery of cardiac function and of the hepatic graft. Coronary syndrome and acute myocarditis were excluded as the causes of the shock. The use of extracorporeal membrane oxygenation in this scenario is possible and safe, considering its specialized protocols and treatment.
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Affiliation(s)
- Rodrigo Santos Biondi
- Unidade de Terapia Intensiva Cirúrgica, Instituto de
Cardiologia do Distrito Federal - Brasília (DF), Brasil
- Corresponding author: Rodrigo Santos Biondi, Instituto
de Cardiologia do Distrito Federal, Setor HFA - Hospital das Forças
Armadas Setor Sudoeste, S/Nº, Zip code: 70.673-900 - Brasília (DF),
Brazil, E-mail:
| | - Vitor Salvatore Barzilai
- Unidade de Terapia Intensiva Cirúrgica, Instituto de
Cardiologia do Distrito Federal - Brasília (DF), Brasil
| | - André Luis Conde Watanabe
- Unidade de Transplante Hepático, Instituto de Cardiologia do
Distrito Federal - Brasília (DF), Brasil
| | | | - Fernando Antibas Atik
- Departamento de Cirurgia Cardíaca, Instituto de Cardiologia
do Distrito Federal - Brasília (DF), Brasil
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Mending a Broken Heart: Treatment of Stress-Induced Heart Failure after Solid Organ Transplantation. J Transplant 2018; 2018:9739236. [PMID: 29670765 PMCID: PMC5835255 DOI: 10.1155/2018/9739236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/03/2017] [Accepted: 12/14/2017] [Indexed: 02/07/2023] Open
Abstract
Stress-induced heart failure, also known as Broken Heart Syndrome or Takotsubo Syndrome, is a phenomenon characterized as rare but well described in the literature, with increasing incidence. While more commonly associated with postmenopausal women with psychiatric disorders, this entity is found in the postoperative patient. The nonischemic cardiogenic shock manifests as biventricular failure with significant decreases in ejection fraction and cardiac function. In a review of over 3000 kidney and liver transplantations over the course of 17 years within two transplant centers, we describe a series of 7 patients with Takotsubo Syndrome after solid organ transplantation. Furthermore, we describe a novel approach of successfully treating the transient, though potentially fatal, cardiogenic shock with a percutaneous ventricular assistance device in two liver transplant patients, while treating one kidney transplant patient medically and the remaining four liver transplant patients with an intra-aortic balloon pump. We describe our experience with Takotsubo's Syndrome and compare the three modalities of treatment and cardiac augmentation. Our series is novel in introducing the percutaneous ventricular assist device as a more minimally invasive intervention in treating nonischemic heart failure in the solid organ transplant patient, while serving as a comprehensive overview of treatment modalities for stress-induced heart failure.
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Sonny A, Govindarajan SR, Jaber WA, Cywinski JB. Systolic heart failure after liver transplantation: Incidence, predictors, and outcome. Clin Transplant 2018; 32:e13199. [DOI: 10.1111/ctr.13199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Abraham Sonny
- Department of Cardiothoracic Anesthesiology; Anesthesiology Institute; Cleveland Clinic; Cleveland OH USA
| | | | - Wael A. Jaber
- Department of Cardiovascular Medicine; Heart and Vascular Institute; Cleveland Clinic; Cleveland OH USA
| | - Jacek B. Cywinski
- Departments of General Anesthesiology; Transplant Center and Outcomes Research; Anesthesiology Institute; Cleveland Clinic; Cleveland OH USA
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EXP CLIN TRANSPLANTExp Clin Transplant 2017; 15. [DOI: 10.6002/ect.2017.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Agarwal S, Bean MG, Hata JS, Castresana MR. Perioperative Takotsubo Cardiomyopathy: A Systematic Review of Published Cases. Semin Cardiothorac Vasc Anesth 2017; 21:277-290. [PMID: 29098955 DOI: 10.1177/1089253217700511] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Takotsubo cardiomyopathy (TCM) is a condition that is characterized as a transient ventricular dysfunction in the absence of obstructive coronary artery disease (CAD) and is usually triggered by an acute medical illness or intense physical or emotional stress. Multiple cases of perioperative TCM (pTCM) have been reported from around the world, but a qualitative analysis of these cases has not yet been done. For this systematic review, we searched PubMed for case reports and case series of pTCM published from 1966 to April 2015 with the objective being to evaluate whether differences in demographics, clinical features and outcomes exist between pTCM and nonperioperative (npTCM), as well as to attempt to identify any predictors of the severe form of pTCM, which requires mechanical circulatory support (MCS) devices or leads to death. A total of 93 articles describing 102 cases were retrieved and reviewed. The findings were compared with the analysis of the International Takotsubo Registry by Templin et al and a systematic review of mainly non-perioperative TCM (npTCM) by Gianni et al. Although we were unable to identify definitive risk factors for pTCM, our review suggests that pTCM appears to occur in younger patients and with a lower likelihood of ST segment elevations and T-wave abnormalities than in npTCM. No demographic or clinical factors were identified that were predictive of more severe outcomes. As TCM in general can be a life-threatening event, it would therefore be prudent to consider pTCM within a differential diagnosis in any patient who decompensates in the perioperative period.
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13
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Elapavaluru S, Gologorsky A, Thai N, Uemura T, Khalil R, Mareddy C, Dishart M, Gologorsky E. Perioperative Stress Cardiomyopathy in Simultaneous Liver and Kidney Transplantation: A Call for Early Consideration of Mechanical Circulatory Support. J Cardiothorac Vasc Anesth 2017; 31:248-253. [DOI: 10.1053/j.jvca.2016.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Indexed: 11/11/2022]
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Takotsubo cardiomyopathy and its relevance to anesthesiology: a narrative review. Can J Anaesth 2016; 63:1059-74. [DOI: 10.1007/s12630-016-0680-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 04/21/2016] [Accepted: 06/02/2016] [Indexed: 12/14/2022] Open
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Mukhtar A, Moharam H, Sarhan K, Hosni H, Salah M. Liver Transplantation Using Dexmedetomidine in a Patient with a History of Takotsubo Cardiomyopathy. ACTA ACUST UNITED AC 2016; 6:14-6. [DOI: 10.1213/xaa.0000000000000189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Chiariello GA, Bruno P, Colizzi C, Crea F, Massetti M. Takotsubo Cardiomyopathy Following Cardiac Surgery. J Card Surg 2015; 31:89-95. [DOI: 10.1111/jocs.12675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Giovanni Alfonso Chiariello
- Department of Cardiovascular Sciences; Catholic University of The Sacred Heart; Agostino Gemelli Policlinic Rome Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences; Catholic University of The Sacred Heart; Agostino Gemelli Policlinic Rome Italy
| | - Christian Colizzi
- Department of Cardiovascular Sciences; Catholic University of The Sacred Heart; Agostino Gemelli Policlinic Rome Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences; Catholic University of The Sacred Heart; Agostino Gemelli Policlinic Rome Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences; Catholic University of The Sacred Heart; Agostino Gemelli Policlinic Rome Italy
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