Takotsubo Cardiomyopathy following a L2–L5 Laminectomy and Fusion In Situ with Bone Morphogenic Protein

Abstract

Takotsubo cardiomyopathy (TC) is a rare, transient cardiomyopathy, with symptoms mimicking myocardial infarction. It has been reported to typically occur in postmenopausal women and is often triggered by an intense physical or emotional event with stimulation of the sympathetic response; the exact etiology, however, is uncertain. Bone morphogenic protein (BMP) is widely used in spinal fusions and has been associated with numerous perioperative complications. BMP is known to stimulate sympathetic pathways. In this paper, we present the case of a patient with a 7-hour episode of TC after a spinal fusion with bone morphogenic protein. The patient's symptoms resolved and long-term followup has been uneventful. This is the first paper to describe TC in the setting of spine or other major orthopaedic surgery and it suggests another possible area for further investigation in peri-operative events potentially associated with the use of bone morphogenic protein.

Perioperative Takotsubo Stress Cardiomyopathy During Endoscopic Spinal Surgery

“…Our patient was a young, fit male patient with no evident risk factors. On re-evaluation after recovery, the patient reports being conscious toward the end of the surgery and feeling anxious during position change, which may have compounded the surgical stress and led to the precipitation of perioperative TCM 24 . A sudden surgical pain stimulus, anxiety, combined with insufficient analgesia/sedation, causes a catecholamine surge 1 in perioperative TCM.…”

A Postoperative Complication of Takotsubo Syndrome in the Spinal Surgery: A Case Report

“…Many hypotheses have been generated around cause and pathogenesis; however, endogenous adrenergic augmentation is the most established theory and is intuitive given the strong association with sudden and unexpected stress and a major physical illness or trauma [ 6 ]. The prevalence of this syndrome in postmenopausal women is classically described due to the fact that relative estrogen deficiency results in certain endothelial dysfunction and a reduction in sympathetic tone [ 4 , 7 ]. Similarly, comorbidities associated with chronic coronary microvascular dysfunction, such as diabetes, asthma, and chronic obstructive pulmonary disease, appear to increase susceptibility to myocardial damage after a sudden increase in catecholamines, which may be secondary to an intense emotional stressor event (death of relatives, catastrophic events) or physical (acute respiratory failure, sepsis, surgery) [ 8 ].…”