Takotsubo Cardiomyopathy: A rare cause of postpneumonectomy pulmonary edema

Background:

Takotsubo cardiomyopathy (TC) is characterized by transient systolic and diastolic left ventricular dysfunction with a variety of wall-motion abnormalities with no evidence of coronary artery disease. It predominantly affects elderly women and is mostly induced by physical or emotional stress. It is thought to be a result of catecholamine-induced acute cardiomyopathy. A significant prevalence of malignant diseases in TC patients has been shown in a variety of retrospective studies; however, there are only few reported cases of TC in patients with advanced NSCLC.

Material and method:

We present a case of 62-year-old woman who developed TC with acute pulmonary edema after right intrapericardial pneumonectomy for necrotizing squamous cell lung cancer. On the 10th postoperative day the patient developed tachycardia accompanied by orthopnea. Cardiac troponin T and NT-proBNP levels were elevated. The ECG showed new atrial fibrillation with ST segment elevation and the chest x-ray showed signs of acute pulmonary edema. The coronary angiography showed no coronary artery disease, but apical ballooning which is typically associated with TC. The transesophageal echocardiography revealed a global left ventricular hypokinesis with moderate- to-severe reduced left ventricular systolic function and normal right ventricular systolic function consistent with TC. After successful supportive therapy the patient was discharged home 18 days later. TTE, performed 9 days after discharge showed normal systolic LV function.

Conclusion:

This is the first report of pulmonary edema complicating TC occurring after pneumonectomy for NSCLC which could extend the differential diagnosis of cardiac complications after oncological lung surgeries. Further studies are needed to assess the perioperative changes of left ventricular functions in patients undergoing pulmonary resections for advanced NSCLC considering the role of catecholamines as a mediator of tumor progression and in the pathophysiology of TC.