Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement

Sung, June Min; Hong, Sung Jin; Chung, In Hyun; Lee, Hye Young; Lee, Jae Hoon; Kim, Hyun Jung; Byun, Young Sup; Kim, Byung Ok; Rhee, Kyehan

doi:10.3349/ymj.2017.58.1.248

Cited by 12 publications

(4 citation statements)

References 11 publications

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“…Mitral regurgitation can be caused by leaflet tethering due to geometrical changes in the LV (according to TS pattern) and the displacement of the papillary muscles or by SAM [ 53 , 54 ]. Although a rare instance, LV free wall or interventricular septal rupture may occur [ 55 , 56 , 57 , 58 , 59 ]. Apical akinesia may promote intraventricular thrombosis and furthermore thromboembolic events may occur [ 56 , 60 ].…”

Section: Standard Echocardiographymentioning

confidence: 99%

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

Paraschiv,

Paduraru,

Balanescu

2023

Rev. Cardiovasc. Med.

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Takotsubo Syndrome (TS) is an acute, reversible cardiac dysfunction, with complex, not entirely understood pathophysiology and heterogeneous clinical picture. Imaging methods each have a crucial role in the diagnosis, in-hospital management, short term and long term follow up. Coronary angiography needs to be performed, especially in the setting of a suspected acute coronary syndrome, in order to rule out coronary artery disease. Echocardiography plays a central role both in the acute and the chronic phase. It is the first imaging investigation performed in patients with TS, valuable to diagnose systolic dysfunction, the wall motion pattern and early complications. Cardiac magnetic resonance tissue characterization provides an essential role in the differential diagnosis of TS with other non-ischemic causes of systolic dysfunction. This review focuses on the imaging methods and the important part they play in the complex management of the disease.

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Section: Standard Echocardiographymentioning

confidence: 99%

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

Paraschiv,

Paduraru,

Balanescu

2023

Rev. Cardiovasc. Med.

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“…Although a few papers reported that the earliest time of recurrence was 8 days [4,6], in most cases, a relapse occurs within a few months or years [1,4,6,[9][10][11][12][13]. Severe complications, including arrythmia, acute cardiac shock and cardiac rupture may arise [1,4,[14][15][16][17][18]; however, takotsubo cardiomyopathy is typically a reversible functional disorder and autopsy cases are rare [19]. In most cases, macroscopic study of the heart shows focal damage, such as rupture, or the absence of structural change [20,21].…”

Section: Introductionmentioning

confidence: 99%

Serious takotsubo cardiomyopathy: an autopsy case presenting severe irreversible myocardial damage after frequent episodes of recurrence

Mizutani

Shioya

et al. 2020

Diagn Pathol

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Background: Takotsubo cardiomyopathy is characterized by transient dysfunction of the medial to apical segment of the left ventricle. Recurrence within a few months or years has been reported and serious complications, including arrhythmia, acute cardiac shock and cardiac rupture, can arise; however, recurrence is rare and takotsubo cardiomyopathy is typically a reversible functional disorder. Case presentation: A 91-year-old Japanese woman with a past medical history of angina pectoris, hypertension and uterine carcinoma noted bilateral axillary pain and presented herself to an emergency room. Although the pain improved and she went home, there were several subsequent episodes of recurrent chest pain. At approximately 1 week after the onset, she was hospitalized as her symptom worsened. Electrocardiography showed low voltage in limb and chest leads, and ST-segment elevation in leads II, III, aVF and V3 to V6. Echocardiography revealed medial to apical dyskinesia and basal hypercontractility of the left ventricle, and cardiac tamponade. Pericardiocentesis improved the symptom, but not her cardiac dysfunction. At 3 days after her admission, cardiopulmonary resuscitation was performed due to ventricular fibrillation. She died on the 5th day of admission (2 weeks after the onset). At autopsy, the left ventricle was dilatated and the apical ventricular wall was thin. On microscopy, remarkable wavy change and thinning of myocardium were diffusely observed, especially at the apex and the anterior to lateral wall of the left ventricle, interventricular septum and right ventricle, intermingled with interstitial fibrosis, hemorrhage and neutrophil infiltration. Contraction band necrosis was mainly observed on the posterior to inferior wall of the left ventricle. Conclusion: Our case showed severe morphological myocardial change after several chest pain episodes that were considered to be takotsubo cardiomyopathy. This notable case suggests that the frequent recurrence of serious takotsubo cardiomyopathy is life threatening and can lead to irreversible serious myocardial degeneration.

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“…This can lead to left ventricular rupture and recent studies reported right ventricular involvement in 28% -50% [9] [10], the friable right ventricle susceptible to rupture due to mechanical wall stress in biventricular Takotsubo cardiomyopathy [11]. Isolated RV free wall rupture as a complication of inferior wall and right ventricular myocardial infarction is an uncommon finding in transthoracic echocardiographic examination [12] and it was reported in Figure 1 to Figure 6.…”

Section: Introductionmentioning

confidence: 99%

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

Muthiah¹

2017

CRCM

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Introduction: To present a rare occurrence of "Swiss-cheese" defects of left ventricle in acute myocardial infarction. Case Report: A 64-year-old male with persistent ST segment elevation in anterior and inferior leads developed sudden deterioration within 2 days after thrombolysis. Echocardiography revealed ventricular septal and LV (left ventricular) free wall ruptures at multiple sites with contractile dysfunction and the patient died suddenly, followed by an episode of ventricular tachycardia. Discussion: Myocardial rupture may complicate in 10% of acute myocardial infarctions and it is the second most common cause of in-hospital mortality next to pump failure. It is responsible for 15% of in-hospital deaths and 50% died within 5 days and 82% died within two weeks of index infarction. Conclusion: Aggressive early diagnosis and surgery may confer a survival rate as high as 75%. The prognosis is grave in patients presented with cardiogenic shock and multiorgan dysfunction; surgery is best avoided and supportive medical therapy may be adequate in such cases.

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Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement

Cited by 12 publications

References 11 publications

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

An Extensive Review on Imaging Diagnosis Methods in Takotsubo Syndrome

Serious takotsubo cardiomyopathy: an autopsy case presenting severe irreversible myocardial damage after frequent episodes of recurrence

“Swiss-Cheese” Left Ventricle in Acute Myocardial Infarction—A Case Report

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