Thorac Cardiovasc Surg 2011; 59(8): 500-503
DOI: 10.1055/s-0030-1270798
Case Reports
Cardiovascular
© Georg Thieme Verlag KG Stuttgart · New York

Late Onset Takotsubo Cardiomyopathy after Mitral Valve Replacement

G. Färber1 , A. Mühle2 , T. Doenst1 , M. A. Borger2 , F.-W. Mohr2
  • 1Department of Cardiothoracic Surgery, University of Jena, Jena, Germany
  • 2Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
Further Information

Publication History

received October 25, 2010 resubmitted December 25, 2010

accepted January 3, 2011

Publication Date:
25 March 2011 (online)

Abstract

We report a case of delayed onset Takotsubo cardiomyopathy (TC) in a 69-year-old woman, associated with minor stressors, two weeks after mitral valve replacement. After suffering several minor complications she had fully recovered and her discharge was planned. On the 14th postoperative day she had to be resuscitated due to cardiogenic shock. TC was diagnosed based on reduced ventricular function with apical ballooning and normal coronaries. Treatment with catecholamines and intra-aortic balloon pump led to full recovery. She continues to do well two years after surgery. TC should be considered as a potential cause of delayed ventricular dysfunction in postcardiac surgery patients.

References

  • 1 Akashi Y J, Nef H M, Möllmann H, Ueyama T. Stress cardiomyopathy.  Annu Rev Med. 2010;  61 271-286
  • 2 Cebelin M S, Hirsch C S. Human stress cardiomyopathy. Myocardial lesions in victims of homicidal assaults without internal injuries.  Hum Pathol. 1980;  11 123-132
  • 3 Sato T, Sato H, Tateishi H, Uchida T, Dote K. [Distinctive response of coronary artery compared acute myocardial infarction with angina pectoris associated with angioplasty].  Kokyu To Junkan. 1990;  38 887-892
  • 4 Lyon A R, Rees P S, Prasad S, Poole-Wilson P A, Harding S E. Stress (takotsubo) cardiomyopathy – a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning.  Nat Clin Pract Cardiovasc Med. 2008;  5 22-29
  • 5 Kogan A, Ghosh P, Schwammenthal E, Raanani E. Takotsubo syndrome after cardiac surgery.  Ann Thorac Surg. 2008;  85 1439-1441
  • 6 Berman M, Saute M, Porat E et al. Takotsubo cardiomyopathy: expanding the differential diagnosis in cardiothoracic surgery.  Ann Thorac Surg. 2007;  83 295-298
  • 7 García Fuster R, Vázquez A, Peláez A G et al. Factors for development of late significant tricuspid regurgitation after mitral valve replacement: the impact of subvalvular preservation.  Eur J Cardiothorac Surg. 2010;  DOI: 10.1016/j.ejcts.2010.11.014
  • 8 Rozich J D, Carabello B A, Usher B W et al. Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation. Mechanisms for differences in postoperative ejection performance.  Circulation. 1992;  86 (6) 1718-1726
  • 9 Muthialu N, Varma S K, Ramanathan S et al. Effect of chordal preservation on left ventricular function.  Asian Cardiovasc Thorac Ann. 2005;  13 (3) 233-237
  • 10 Yoshioka T, Hashimoto A, Tsuchihashi K et al. Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (tako-tsubo cardiomyopathy).  Am Heart J. 2008;  155 526.e1-e7

Dr. med. Gloria Färber

Department of Cardiothoracic Surgery
University of Jena

Erlanger Allee 101

07740 Jena

Germany

Phone: +49 3 64 19 32 29 65

Fax: +49 3 64 19 32 29 02

Email: gloria.faerber@med.uni-jena.de