Key result
An 82-year-old woman developed Takotsubo cardiomyopathy with left ventricular outflow tract obstruction (pressure gradient 38 mmHg) on postoperative day 1 after mitral valve replacement, which resolved by day 34.
Case Report (n=1)
No
This case highlights that patients with a sigmoid septum may be at risk for developing Takotsubo cardiomyopathy with left ventricular outflow tract obstruction after mitral valve replacement, especially when exposed to strong catecholamines and hypovolemia.
Answers are grounded in this paper and cite their sources.
May raise awareness for Takotsubo cardiomyopathy with LVOTO after mitral valve replacement; leaves open sigmoid septum as a risk factor.
S字状中隔（sigmoid septum）を有する高齢女性で，僧帽弁置換術後に左室流出路閉塞を伴うたこつぼ心筋障害を発症した1例を経験した．本例はsigmoid septumの病的意義を示し，左室流出路閉塞がたこつぼ心筋障害の発症と重症化に関係すると考えられたので報告する．症例は胸水貯留と下腿浮腫を有する82歳女性．リウマチ性僧帽弁膜症（閉鎖不全兼狭窄症），二次性三尖弁閉鎖不全症，慢性心房細動，肺高血圧症と診断され，sigmoid septumを認めた．麻酔導入後に徐脈と血圧が低下し，アドレナリンとノルアドレナリンを使用した．手術中，経食道超音波検査では局所壁運動異常を認めなかった．ステント付き牛心嚢膜弁27 mmを用いて僧帽弁置換術，DeVega法による三尖弁形成術，メイズ手術を施行した．手術翌日，気管チューブ抜去後血圧低下を認めた．経胸壁心臓超音波検査で左室心尖部の無収縮，バルーン状拡張と心基部の過収縮を認め，圧較差38 mmHgの左室流出路閉塞を伴うたこつぼ心筋障害と診断した．アドレナリンの減量と輸血により左室流出路閉塞は消失し，術後34日目に心尖部の無収縮は改善した．術前後の冠動脈造影検査に異常を認めなかった．
No takes yet. Share an insight, caveat, or question.
Minamimura et al. (2016) conducted a case report in Takotsubo cardiomyopathy with left ventricular outflow tract obstruction (n=1). Mitral valve replacement was evaluated on Development and resolution of Takotsubo cardiomyopathy with LVOTO. An 82-year-old woman developed Takotsubo cardiomyopathy with left ventricular outflow tract obstruction (pressure gradient 38 mmHg) on postoperative day 1 after mitral valve replacement, which resolved by day 34.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: