Diagnostic and therapeutic challenges in pediatric takotsubo syndrome: a case report

Olga C. Maza-Caneva, Facultad de Ciencias de la Salud, Universidad Libre Barranquilla; Departamento de Cardiología, Organización Clínica General del Norte, Barranquilla, Colombia
Ricardo A. Villa-Vargas, Departamento de Cardiología, Organización Clínica General del Norte, Barranquilla, Colombia
Andrea C. Restrepo-Hincapié, Facultad de Ciencias de la Salud, Universidad Libre Barranquilla, Barranquilla, Colombia
Carmen M. De la Rosa-Villalba, Facultad de Ciencias de la Salud, Universidad Libre Barranquilla, Barranquilla, Colombia
María C. Sanjuanelo-Patiño, Facultad de Ciencias de la Salud, Universidad Simón Bolívar, Barranquilla, Colombia

Takotsubo syndrome is a transient cardiomyopathy that is uncommon in pediatric patients, characterized by acute left ventricular dysfunction and regional wall motion abnormalities in the absence of obstructive coronary artery disease. Its recognition in children remains challenging because of its low incidence and its overlap with other causes of hemodynamic deterioration, particularly in the postoperative cardiovascular setting. We report the case of a 15-year-old adolescent with Barlow syndrome and severe mitral regurgitation who underwent mechanical mitral valve replacement. During the procedure, findings suggestive of endocarditis were identified and subsequently confirmed by isolation of Serratia marcescens. On postoperative day 4, the patient developed hemodynamic deterioration requiring vasoactive support, with moderate elevation of cardiac biomarkers and an echocardiographic pattern consistent with takotsubo syndrome, characterized by apical and midventricular akinesia, compensatory basal hypercontractility, and a left ventricular ejection fraction of 35%. Given the limited response to catecholamines, levosimendan was administered, with progressive clinical improvement. In the third postoperative week, cardiac magnetic resonance imaging ruled out myocarditis and demonstrated in-hospital functional recovery. This case highlights the importance of considering takotsubo syndrome in the differential diagnosis of postoperative hemodynamic deterioration in pediatric patients, particularly when echocardiography reveals typical segmental abnormalities that allow early diagnostic suspicion and timely management.

Keywords: Takotsubo syndrome. Stress cardiomyopathy. Mitral valve surgery. Infective endocarditis. Pediatrics.