Surgical treatment for ventricular septal perforation in Takotsubo syndrome could potentially be deferred if hemodynamic stability is maintained, as LV function recovery can be anticipated.
While VSP is a potentially lethal complication of TTS, recovery of LV function can be anticipated, suggesting that surgical treatment could be deferred, provided that hemodynamic stability is maintained. This case demonstrates that focal myocardial necrosis can occur in TTS. Furthermore, increased wall tension occurs in the ballooning segments during systole, as the LV radius increases and the ventricular wall fails to thicken, in accordance with Laplace's law. Both myocardial fragility resulting from focal myocardial necrosis and increased LV wall tension due to systolic ballooning are considered to be key mechanisms underlying the development of VSP in TTS.
Yoshikai et al. (Thu,) studied this question.