Extracorporeal Membrane Oxygenation in the Management of Takotsubo Cardiomyopathy Secondary to Mitral Valve Replacement Surgery: A Case Report.

Unlike classical myocardial infarction, acute emotional or physical stress can trigger distinct but transient wall motion abnormalities with patent coronary arteries. Takotsubo cardiomyopathy (TC) classically presents as systolic and diastolic left ventricular (LV) dysfunction, which is widely accepted to be secondary to catecholamine-induced microvascular dysfunction. Our case report describes a 26-year-old female undergoing mitral valve replacement (MVR) surgery for infective endocarditis and postoperatively developing TC. Severe hemodynamic instability with low mean arterial pressure necessitated emergency intubation and ventilation. Bedside formal echocardiography reported mid and apical segment akinesia with significant left ventricular systolic dysfunction. This case identifies a potential cause of sudden-onset heart failure (HF) in patients with critical illness. The early recognition and appropriate management of TC are highlighted in this article, particularly in high-risk patients undergoing cardiac surgery. In recent years, extracorporeal membrane oxygenation (ECMO) has presented a unique opportunity to mechanically manipulate pulmonary vascular pressure. TC is a unique and uncommon cause of sudden-onset heart failure in patients with critical illnesses. This article illustrates the importance of the early recognition and management of TC with ECMO. Considering the rarity of TC, randomized controlled trials are yet to establish optimal management strategies for specific etiology. Further research and case series are vital to enhance our understanding of the vital use of ECMO in the treatment of takotsubo cardiomyopathy secondary to MVR.