Takotsubo syndrome following mitral valve surgery in a paediatric patient: a case report

Background: Takotsubo syndrome is an uncommon condition in children, mainly triggered by physical stressors. However, it has never been described after a mitral valve surgery in this population. Case summary: We present the case of a 14-year-old boy with a history of Loeys-Dietz syndrome, who had previously undergone aortic root replacement due to an aortic aneurysm. He was admitted for elective mitral valve repair due to asymptomatic severe primary mitral regurgitation caused by bileaflet prolapse. Mitral valve repair was performed without incidences, but in the postoperative, he developed cardiogenic shock and cardiorespiratory arrest. Echocardiography showed severe left ventricular dysfunction with mid to distal diffuse hypokinesia, with better contractility in basal segments. Extracorporeal membrane oxygenation was required for 48 h, after which his haemodynamic status improved, leading to a gradual reduction in supportive measures. Control echocardiogram showed partial recovery of the left ventricular function with improved contractility in apical segments. The patient could be discharged at 2 weeks. One month later, he remained asymptomatic, with a normal left ventricular ejection fraction. Discussion: Takotsubo syndrome can be a life-threatening condition, with a higher prevalence of acute complications in male patients. Reports of this syndrome after cardiac surgery have mostly involved the mitral valve, which could be explained by the abrupt change in ventricular loading conditions and increase in afterload. The immediate postoperative use of epinephrine and dobutamine has been identified as a risk factor for the development of Takotsubo syndrome. Despite initially considered a benign entity, Takotsubo syndrome can be a life-threatening condition, with a mortality risk similar to patients presenting with acute coronary syndromes. Mitral valve surgery may serve as a trigger for Takotsubo syndrome and should be considered as a potential differential diagnosis in patients presenting with postoperative cardiogenic shock.