Maeba Hirofumi, Takehana Kazuya, Kanazawa Takenori, Ueyama Takanao, Tsujimoto Satoshi, Suwa Yoshinobu, Miyasaka Yoko, Yuasa Fumio, Kamihata Hiroshi, Iwasaka Toshiji
Cardiovascular Division, Department of Medicine II, Kansai Medical University, Hirakata, Osaka, Japan.
J Cardiol Cases. 2012 Jun 6;6(3):e70-e74. doi: 10.1016/j.jccase.2012.05.001. eCollection 2012 Sep.
Although some atypical types of transient left ventricular apical ballooning syndrome have been reported, only a few atypical types of transient mid-ventricular ballooning have been reported. A 70-year-old female underwent surgery for urothelial carcinoma. At day 5 after the surgery, she was admitted to our department without cardiac symptoms because of ST elevation in leads I, II, III, aVF and V1-V6 indicating acute coronary syndrome. She was diagnosed with stress induced cardiomyopathy based on an angiographically normal coronary artery, newly developed extensive wall motion abnormality (hyperbasal contraction and akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex) based on left ventriculography, and a small elevation of myocardial enzymes incongruous with the area of contraction abnormality. Myocardial scintigraphy with Tc-tetrofosmin showed a severely reduced myocardial perfusion in an extensive mid-ventricular area without a left ventricular base and top of apex, in accord with a wall motion abnormality different from typical apical ballooning or typical mid-ventricular ballooning previously diagnosed in our hospital. This is the first report presenting an atypical mid-ventricular ballooning based on the myocardial atypical perfusion findings.
尽管已经报道了一些非典型类型的短暂性左心室心尖气球样综合征，但仅有少数非典型类型的短暂性心室中部气球样变被报道。一名70岁女性因尿路上皮癌接受手术。术后第5天，她因I、II、III、aVF及V1-V6导联ST段抬高提示急性冠状动脉综合征而入住我科，但无心脏症状。基于冠状动脉造影正常、左心室造影显示新出现的广泛室壁运动异常（从左心室中部至心尖的基底段收缩增强及运动不能，心尖旁小区域无收缩增强）以及心肌酶轻度升高与收缩异常区域不符，她被诊断为应激性心肌病。锝-替曲膦心肌显像显示在心室中部广泛区域心肌灌注严重减低，不累及左心室基底段和心尖顶部，这与我院之前诊断的典型心尖气球样变或典型心室中部气球样变不同的室壁运动异常相符。这是基于心肌非典型灌注表现呈现非典型心室中部气球样变的首例报道。
