Takotsubo Cardiomyopathy Following Cardiac Surgery

Abstract

Background: Takotsubo cardiomyopathy syndrome, commonly occurring in postmenopausal women, is characterized by transient apical systolic dysfunction in absence of coronary lesions. The cardiomyopathy is often observed after intense stressful events such as a major surgical procedure. Methods: A 72-year-old woman symptomatic for dyspnea at rest, chest pain, and peripheral edema successfully underwent surgery for noncoronary sinus aneurysm-right atrium fistula repair. Two days after surgery the patient developed takotsubo syndrome, diagnosed according to the Mayo Clinic criteria. We reviewed the literature on takotsubo cardiomyopathy as a complication of major cardiac surgery procedures. Results: Takotsubo cardiomyopathy is confirmed as a possible early complication of cardiac surgery. Exaggerated sympathetic stimulation may cause massive endogenous catecholamine release. Hypoperfusion during cardiopulmonary bypass, inotropic drugs administration, and postoperative anxiety and pain are all factors generating stress, possible coronary artery spasm and transient cardiomyopathy, clinically simulating acute myocardial infarction. Several clinical features have been described such as acute mitral insufficiency, systolic anterior motion of the anterior mitral valve leaflet, left ventricular outflow tract obstruction, acute cardiac failure, and cardiogenic shock. Intraventricular thrombi and adverse cerebrovascular events may also be possible complications. Rare catastrophic events such as left ventricular free wall rupture and ventricular septal perforation have been also encountered. Conclusions: After cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started.

Takotsubo Cardiomyopathy with Extracorporeal Membrane Oxygenation (ECMO) Requirement after Atrial Myxoma Surgery

“…All cases developed after mitral valve surgery. 9 We describe the first case of Takotsubo cardiomyopathy after atrial myxoma surgery.…”

Extracorporeal membrane oxygenation for takotsubo cardiomyopathy that developed after mitral valve replacement

“…Takotsubo cardiomyopathy is triggered by emotional or physical stress. Takotsubo cardiomyopathy associated with surgery is reported to account for 3%-23% of all cases, and cardiomyopathy developing after cardiothoracic surgery accounted for 16% of these perioperative cases [6][7][8]. Patients suffer emotional stress at the prospect of undergoing a major surgery, and they also experience increased catecholamines by direct stimulation of pain.…”

Miocardiopatía por estrés: análisis de 17 casos

“…Más aún, se postula que esta es inducida comúnmente donde hay disfunciones cardíacas similares en pacientes con feocromocitoma y casos de desarrollo de MCS secundario a la administración de epinefrina y dobutamina 22,23,39-41-43 . Se han descripto como factores desencadenantes, factores emocionales (happy and broken heart syndrome) o físicos (esfuerzos, traumatismos, patologías agudas cardíacas y no cardíacas, infecciones, cirugías, inducción anestésica, uso de inotrópicos, intoxicaciones y quimioterapia) [9][10][11][12][13][14][15][16][17][18][19] . La presentación clínica característica corresponde a la de un SCA, con dolor precordial anginoso, signosintomatología simpática, disnea de esfuerzo y cambios electrocardiográficos de isquemia o injuria.…”

“…Dentro de los psicológicos se han reportado diversas situaciones (negativas o positivas), así como una gran variabilidad en la intensidad de estos gatillos 8 . También los desencadenantes físicos descriptos corresponden a diferentes etiologías tales como, esfuerzo físico extremo, patologías clínicas agudas, exacerbaciones de patologías crónicas, cirugías mayores, quimioterapia e inducción anestésica [9][10][11][12][13][14][15][16][17][18][19] . La presentación clínica típica corresponde a la de un SCA, con dolor precordial anginoso, signosintomatología simpática, disnea de esfuerzo y cambios electro-cardiográficos de isquemia o injuria; también puede presentarse asintomático o con ángor atípico, disnea, síncope, palpitaciones, náuseas y/o emesis, mialgias, falla cardíaca aguda, arritmia ventricular, shock cardiogénico, paro cardiorrespiratorio e incluso muerte súbita .…”