Lescan Mario, Walker Tobias, Kobba Joseph, Schneider Wilke, Schlensak Christian
Department of Cardiovascular and Thoracic Surgery, University Hospital Tuebingen, Hoppe Seyler Straße 3, 72076, Tuebingen, Germany,
Gen Thorac Cardiovasc Surg. 2014 Jan;62(1):64-7. doi: 10.1007/s11748-013-0212-x. Epub 2013 Feb 2.
We report a case of a 43-year-old woman, who presented with thoracic interscapular pain at a peripheral hospital. In addition, the patient reported retrosternal pain, which had occurred only hours before-after an upsetting telephone call. The CT imaging ruled out an aortic dissection but revealed a huge sinus valsalva aneurysm (SVA) while the laboratory parameters showed slightly elevated troponin T value. Echocardiography showed an akinesia of the midventricular and apical left ventricular wall, accompanied by normal basal contractility. Stenotic coronary disease and endomyocarditis could be excluded as the origin of the contractility disorders. The synopsis of the findings and patient's medical history led to the assumption of the takotsubo cardiomyopathy triggered by stress due to the worrying telephone call and the pain originating from the symptomatic SVA. We decided to perform an elective operation of the symptomatic aneurysm after restitution of the ejection fraction--as expected in takotsubo cardiomyopathy--instead of an emergency operation.
我们报告一例43岁女性病例，该患者在外院出现胸背部肩胛间区疼痛。此外，患者自述胸骨后疼痛，仅在一次令人心烦的电话通话数小时前后出现。CT成像排除了主动脉夹层，但显示有一个巨大的主动脉窦瘤（SVA），而实验室检查参数显示肌钙蛋白T值略有升高。超声心动图显示左心室中部和心尖部室壁运动减弱，同时基底段收缩功能正常。可排除狭窄性冠状动脉疾病和心内膜炎作为收缩功能障碍的病因。综合检查结果和患者病史，推测是由于那次令人担忧的电话通话所导致的应激反应以及有症状的SVA引发的疼痛，进而诱发了应激性心肌病。我们决定在射血分数恢复后——正如应激性心肌病所预期的那样——对有症状的动脉瘤进行择期手术，而非急诊手术。
