Suzuki Tsuyoshi, Nemoto Chiaki, Ikegami Yukihiro, Yokokawa Tetsuro, Tsukada Yasuhiko, Abe Yoshinobu, Shimada Jiro, Takeishi Yasuchika, Tase Choichiro
Department of Emergency and Critical Care Medicine, Fukushima Medical University School of Medicine, Hikarigaoka-1, Fukushima, Fukushima, 960-1295, Japan,
J Anesth. 2014 Feb;28(1):121-4. doi: 10.1007/s00540-013-1677-6. Epub 2013 Jul 23.
Takotsubo cardiomyopathy is an acute syndrome involving apical ballooning and consequent dysfunction of the left ventricle. Most cases of left ventricular dysfunction resolve within 1 month. We present the case of a 40-year-old woman who developed severe heart failure caused by takotsubo cardiomyopathy with severe left ventricular dysfunction during the perinatal period. Because of the presence of multiple myomas, she was scheduled to undergo a cesarean section under general anesthesia. However, after induction of general anesthesia, she had to be awakened because of the presence of a difficult airway. Because she exhibited insufficient oxygenation, she was transferred to the emergency center. Upon hospital admission, she expectorated large amounts of pink sputum, indicating severe pulmonary edema. Cesarean section was performed immediately. Echocardiography revealed severe left ventricular dysfunction. Full recovery of cardiac function required almost 1 month, after which she was discharged from the hospital without further complications. This is the first reported case of takotsubo cardiomyopathy induced by a failed intubation during a scheduled cesarean section. Takotsubo cardiomyopathy usually shows a good prognosis, but if this myopathy develops during the perinatal period, it can worsen because of excessive preload following the termination of fetoplacental circulation.
应激性心肌病是一种急性综合征，表现为心尖部气球样变及随之而来的左心室功能障碍。大多数左心室功能障碍病例在1个月内可恢复。我们报告一例40岁女性病例，该患者在围产期因应激性心肌病伴严重左心室功能障碍而发生严重心力衰竭。由于存在多个子宫肌瘤，她计划在全身麻醉下行剖宫产术。然而，全身麻醉诱导后，因气道困难不得不唤醒她。由于她出现氧合不足，被转至急诊中心。入院时，她咳出大量粉红色痰液，提示严重肺水肿。立即行剖宫产术。超声心动图显示严重左心室功能障碍。心脏功能完全恢复需要近1个月时间，之后她出院，无进一步并发症。这是首例报道的在计划剖宫产术中因插管失败诱发应激性心肌病的病例。应激性心肌病通常预后良好，但如果这种心肌病在围产期发生，由于胎儿胎盘循环终止后前负荷过重，病情可能会恶化。
