A new onset acute heart failure (HF) with a sudden drop in the left ventricular ejection fraction (LVEF) post orthotopic liver transplant (LT) is a rare but a potentially fatal complication. Because in most of the cases there is no evidence of coronary thrombosis, it can be classified as nonischemic cardiomyopathy. More specifically, clinical presentation of this syndrome shares many features with stress-induced or takotsubo cardiomyopathy. The known factors that predispose these patients to acute HF during or shortly after LT include cirrhotic cardiomyopathy, rapid hemodynamic changes during LT surgery, and the large concentrations of catecholamines, either administered or released endogenously during surgery. The hemodynamic changes during surgery, such as the drop in preload during the anhepatic phase (occasionally requiring massive transfusions and vasopressors) and subsequent increase in preload with acidic and hyperkalemic plasma in the reperfusion phase, lead to rapid electrolyte and hemodynamic shifts. In several cases, intraoperative onset of HF, with or without ventricular arrythmia, could be timed to the reperfusion phase (and occasionally in the anhepatic and pre-anhepatic phases). In other cases, the HF syndrome started hours to days post-surgery. Recovery of cardiac function occurred in the majority of patients during the same admission; however, these patients generally need significantly longer hospitalizations and aggressive supportive care (occasionally requiring mechanical ionotropic and ventilatory support). If recover, the patients have a similar 1-year mortality as those LT patients that did not have this complication. Because no reliable risk stratification currently exists, intraoperative transesophageal echocardiography might be the most dependable way of detecting and addressing this syndrome promptly. Given the mechanism of takotsubo cardiomyopathy, beta-blockade and a preferential use of non-catecholaminergic vasopressors may be a reasonable way to manage this syndrome.

原位肝移植 (LT) 后左心室射血分数 (LVEF) 突然下降的新发急性心力衰竭 (HF) 是一种罕见但可能致命的并发症。因为在大多数情况下没有冠状动脉血栓形成的证据，它可以归类为非缺血性心肌病。更具体地说，这种综合征的临床表现与压力诱发的或 takotsubo 心肌病有许多共同特征。在 LT 期间或之后不久，使这些患者易患急性 HF 的已知因素包括肝硬化心肌病、LT 手术期间的快速血流动力学变化，以及在手术期间施用或内源性释放的高浓度儿茶酚胺。手术过程中的血流动力学变化，例如无肝期预负荷下降（有时需要大量输血和升压药）以及随后在再灌注期酸性和高钾血浆的预负荷增加，导致电解质和血流动力学快速变化。在一些情况下，术中心衰的发作，无论是否伴有室性心律失常，都可以定时到再灌注期（偶尔在无肝期和无肝期前阶段）。在其他情况下，HF 综合征在手术后数小时至数天开始出现。大多数患者在同一入院期间心脏功能恢复；然而，这些患者通常需要更长的住院时间和积极的支持治疗（偶尔需要机械离子和通气支持）。如果恢复，这些患者的 1 年死亡率与没有这种并发症的 LT 患者相似。由于目前不存在可靠的风险分层，术中经食道超声心动图可能是及时检测和解决该综合征的最可靠方法。鉴于 takotsubo 心肌病的机制，β 受体阻滞剂和优先使用非儿茶酚胺能升压药可能是治疗该综合征的合理方法。