Can a “Broken Heart” Successfully Be Transplanted? A Case Report

Abstract In January 2023 a 59–year–old woman with dilated ischemic cardiomyopathy, was admitted to our Cardiac Surgery Center for a heart transplant eligibility study. She presented symptoms of dyspnea and in the last 6 months was admitted four times to the hospital for heart failure. An echocardiogram showed a severely biventricular hypocontractility (LVEF: 22%; TAPSE 11 mm). After one month, the patient was urgently admitted to our Intensive Care Unit for cardiogenic shock. ECMO VA was implanted percutaneously. Therefore, the patient was placed on the national emergency waitlist for transplantation. A potential donation was identified ten days later. The donor was a 58–year–old woman with no cardiovascular risk factors, had died of a rupture of a cerebral aneurysm. During hospitalization, echocardiography showed LVEF of 30% with akinesia of the middle and apical wall and hyperkinesia of the basal with a mild improvement in contractility (LVEF: 40%) two days later. Coronary angiography was normal. The patient‘s condition resembled Takotsubo syndrome. Virtual and subsequently cytotoxic crossmatch was negative. We proceeded with orthotopic heart transplant. No noteworthy complications occurred during the operation. She received anti–thymocyte immunoglobulin for immunosuppression induction and prednisone, tacrolimus and mycophenolate mofetil for maintenance therapy. The echocardiogram, performed few days later, revealed preserved contractile function in both ventricles (LVEF: 58%). The patient was discharged after the first four endomyocardial biopsies displaying no signs of rejection (ISHLT’04 0R). At ten–month follow–up, the patient is in good clinical condition with no substantial changes during the follow–up echocardiogram. Brain injuries, including subarachnoid haemorrhage, traumatic brain injury and stroke, have been extensively documented in the literature to cause a surge in catecholamines, with a direct effect on the heart, resulting in a transient myocardial dysfunction commonly referred to as ‘Takotsubo cardiomyopathy‘ or ‘broken heart syndrome‘. Studies have shown that dysfunctional hearts at the start of transplant screening have normal contractile function at the time of organ retrieval have similar outcomes to those without dysfunction. This knowledge may help to increase the pool of potential donor hearts and improve the availability of hearts for transplantation, which is crucial given the shortage of suitable donor organs.