Rare but real: Takotsubo syndrome following mitral valve surgery.
- 作者列表："Totaro P","Triolo OF","Argano V
BACKGROUND:Takotsubo syndrome has been widely recognized as a stress cardiomyopathy and only recently has been also reported following cardiac surgery. AIMS:We present a case of takotsubo syndrome two days following a mitral valve replacement with a mechanical prosthesis. MATERIALS AND METHODS:A 64-year-old female patient underwent mitral valve replacement with a mechanical prosthesis. Two days later she presented clinical symptoms and diagnostic evidence supporting the diagnosis of takotsubo syndrome. RESULTS:Patient underwent full left ventricle function recovery and was discharged home on 10th postoperative days. DISCUSSION:The peculiar aspect of this case consist of the early postoperative transthoracic echocardiography, which showed, clearly, an optimal left ventricle function the day before sudden onset of the symptoms, thus allowing for a clear differential diagnosis with other potential causes of postoperative left ventricle failure. CONCLUSION:This case confirms that takotsubo syndrome has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery.
背景: Takotsubo综合征已被广泛认为是一种应激性心肌病，并且直到最近才在心脏手术后被报道。 目的: 我们报告一例takotsubo综合征患者，在二尖瓣置换术后两天内使用机械假体。 材料和方法: 一位64岁的女性患者接受了机械假体二尖瓣置换术。两天后，她提出了支持takotsubo综合征诊断的临床症状和诊断证据。 结果: 患者左心室功能完全恢复，术后第10天出院。 讨论: 这个病例的特殊方面包括术后早期经胸超声心动图，它清楚地显示了症状突然发作前一天的最佳左心室功能，因此允许与术后左心室衰竭的其他潜在原因进行明确的鉴别诊断疾病。 结论: 该病例证实，在鉴别诊断疾病心脏手术后急性左心室功能障碍的情况下，必须仔细考虑takotsubo综合征。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.