Early Postoperative Tako-Tsubo-Like Left Ventricular Dysfunction: Transient Left Ventricular Apical Ballooning Syndrome

Lentschener, Claude; Vignaux, O.; Spaulding, Christian; Bonnichon, P; Legmann, P.; Ozier, Yves

doi:10.1213/01.ane.0000226091.19987.c6

Cited by 45 publications

(41 citation statements)

References 11 publications

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“…Takotsubo cardiomyopathy has been reported during pre-, per-, and postoperative periods but to our knowledge our case is the first observation seen during the induction of general anaesthesia [5][6][7][8][9][10][11]. Transient left ventricular apical ballooning syndrome is a recently recognised entity that mimics acute myocardial infarction without coronary stenosis.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome during induction of general anaesthesia

Jabaudon¹,

Bonnin²,

Bolandard³

et al. 2007

Anaesthesia

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SummaryA 77-year-old female was admitted in our hospital for uterine prolapse surgery. She developed ventricular tachycardia during induction of general anaesthesia and after initial symptomatic measures, she was transferred to the coronary care unit. Heart failure persisted and electrocardiographic changes mimicking acute myocardial infarction appeared. Coronary angiography was normal and left ventriculography revealed akinesis of the apical region of the left ventricle and apical ballooning during systole, with relative sparing of the base of the heart. Complete recovery of left ventricular function occurred 8 days after the initial onset of symptoms. A diagnosis of Takotsubo syndrome was made on the basis of consistent clinical and laboratory findings, typical echocardiography and angiography findings, and reversible course. This case emphasises the importance of being aware of uncommon causes of cardiac dysfunction in stressful situations, especially during induction of general anaesthesia. Takotsubo cardiomyopathy, or transient left ventricular apical ballooning syndrome, was first described in Japan as acute systolic heart failure caused by transient left ventricle apical akinesis [1]. This syndrome is usually triggered by stressful situations, and mainly affects elderly female patients [2]. The peri-operative period is wellknown to induce stress in patients, and this diagnosis should be considered when a patient presents with left ventricular dysfunction or electrocardiographic changes mimicking acute myocardial infarction in stressful situations [3,4], especially during the induction of general anaesthesia. We report the case of a 77-year-old female with Takotsubo syndrome that revealed itself during the induction of general anaesthesia. Case reportA 77-year-old female was admitted to our hospital for vaginal repair of uterine prolapse. She had a history of facial neuralgia treated by clonazepam, venous insufficiency, previous laparotomy under general anaesthesia and bilateral cataract surgery under peribulbar anaesthesia. There were no anaesthetic complications during these procedures. Pre-operative evaluation including electrocardiography was unremarkable, arterial pressure was 150 ⁄ 80 mmHg, and cardiopulmonary auscultation was normal. The patient decided against spinal anaesthesia, and it was therefore decided to administer a targetcontrolled infusion (TCI) of propofol, combined with regional anaesthesia (bilateral paracervical and pudendal nerve blocks). Before transfer to the operating room, the patient received 50 mg hydroxyzine. In addition to standard monitoring, anaesthesia depth monitoring was performed during surgery to measure bispectral index (BIS). Her arterial pressure was 195 ⁄ 92 mmHg, and heart rate was 70 beats.min )1 . Oxygen saturation was 95% with the patient breathing air. Pre-oxygenation was administered until the expired oxygen reached a fraction of 0.9.

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Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome during induction of general anaesthesia

Jabaudon¹,

Bonnin²,

Bolandard³

et al. 2007

Anaesthesia

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“…Stress-induced cardiomyopathy, a now not-so-recently described syndrome has gained substantial notoriety in recent years as described in numerous case reports since it was first described in the early 90's by Sato et al Often mistaken as a myocardial infarction [6,7], patients typically present with chest pain, pulmonary edema [8], prolongation of the QT interval, ST-segment elevation, T-wave inversions and elevated cardiac enzymes [9,10]. A study by Wittstein and colleagues examined 19 patients at the Johns Hopkins University whom developed left ventricular dysfunction shortly after a sudden emotional stress (e.g.…”

Section: Discussionmentioning

confidence: 99%

MRI documentation of Spontaneous Regression of lumbar disc herniation- A case report.

Gupta¹,

Kaur²,

Sandhu³

et al. 2010

IJRA

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We present a case of a 38 year-old morbidly obese female with an unremarkable cardiac history undergoing elective diagnostic laparoscopy for removal of a left ovarian cyst. Despite modified sequence induction and successful intubation, arterial oxygen saturations continued to decline. Bilateral wheezing was heard on auscultation and shortly thereafter, pink frothy liquid filled the endotracheal tube and circuit. Upon stabilizing the patient, radiography and echocardiogram demonstrated diffuse pulmonary vascular congestion and an ejection fraction of 15%, respectively. Remarkably, despite initial elevation in cardiac enzymes and ECG changes, cardiac function completely normalized by hospital day three.

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“…Severe emotional distress is the usual precipitant, however, LVBS has been described in anaphylaxis, pheochromocytoma, the immediate post-operative setting, and has similarities to the cardiac changes seen in sub-arachnoid hemorrhage [13,[15][16][17]. The clinical presentation of LVBS mimics acute ischemia [2].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

Joshi

Chao

Herzka

et al. 2009

Int J Cardiovasc Imaging

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Left ventricular ballooning syndrome (LVBS), also known as Takotsubo cardiomyopathy, is characterized by regional left ventricular dysfunction associated with severe psychological stress. T2 weighted cardiac magnetic resonance (CMR) can identify myocardial edema due to ischemia or other insults. A standard clinical CMR scan with double inversion recovery fast spin echo T2 weighted sequences was performed on consecutive patients with LVBS. T2 signal was compared in myocardial segments with normal and impaired function based on systolic wall thickening (SWT). Eight LVBS patients were identified, all female, with a median age of 61 years and median left ventricular ejection fraction of 52%. Four patients had apical ballooning and four had mid-wall or basal ballooning. In severely dysfunctional segments (those with SWT < 25%), the median percentage of high T2 signal was 85 compared with 35 in those with SWT > 25% (P < 0.001). When the segments were categorized into tertiles based on SWT, the percentage of high T2 signal was greatest in segments with the worst function (68% vs. 43% vs. 31%, P = 0.005). In the five patients who returned for follow up, there was a significant reduction in high T2 signal compared with baseline in those segments that were initially severely dysfunctional (85% vs. 35%, P < 0.001). In conclusion, we describe elevated T2 signal consistent with myocardial edema in patients with LVBS. The T2 signal is highest in myocardium with the most impaired function and resolves over time.

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Early Postoperative Tako-Tsubo-Like Left Ventricular Dysfunction: Transient Left Ventricular Apical Ballooning Syndrome

Cited by 45 publications

References 11 publications

Takotsubo syndrome during induction of general anaesthesia

Takotsubo syndrome during induction of general anaesthesia

MRI documentation of Spontaneous Regression of lumbar disc herniation- A case report.

Cardiovascular magnetic resonance T2 signal abnormalities in left ventricular ballooning syndrome

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