Aalberts Jan J J, Klinkenberg Theo J, Mariani Massimo A, van der Harst Pim
Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, RB Groningen, The Netherlands.
Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eur Heart J Case Rep. 2017 Oct 13;1(1):ytx005. doi: 10.1093/ehjcr/ytx005. eCollection 2017 Aug.
Takotsubo syndrome (TTS) complicated by refractory cardiogenic shock is a challenging clinical problem, as treatment with inotropic agents and/or vasopressors is contraindicated. We illustrate this by a patient presenting with chest pain and shortness of breath caused by TTS complicated by cardiogenic shock requiring mechanical circulatory support (MCS). The patient received central extracorporeal life support with a cannula in the left atrium (pre-load reduction of left ventricle) and the return cannula in the ascending aorta (neutral on afterload). Treatment with MCS was complicated by a cardiac tamponade. Left ventricular function recovered after 24 h, and the patient was doing well at the outpatient clinic 7 weeks after discharge. In addition, we reviewed the literature (PubMed search) reporting on MCS in patients with TTS. Including our patient, 17 cases of TTS induced cardiogenic shock receiving MCS have been reported. Age of the patients ranged from 16 years to 74 years, and 71% of the patients were female. Extracorporeal life support was the most used type of MCS (82% of the cases). Two patients died, and complications of MCS were rare (one case of leg ischaemia). Theoretically, MCS devices that reduce pre-load and are neutral on afterload are preferable. However, no specific type of MCS can be recommended as randomized trials are lacking. In conclusion, our case and the available literature suggests that MCS in TTS induced refractory cardiogenic shock is an immediate and feasible lifesaving treatment.
应激性心肌病（TTS）并发难治性心源性休克是一个具有挑战性的临床问题，因为禁忌使用正性肌力药物和/或血管升压药。我们通过一名因TTS并发心源性休克而出现胸痛和呼吸急促的患者来说明这一点，该患者需要机械循环支持（MCS）。患者接受了中心体外膜肺氧合支持，左心房置管（降低左心室前负荷），升主动脉置回流管（对后负荷无影响）。MCS治疗过程中出现了心脏压塞并发症。24小时后左心室功能恢复，患者出院7周后在门诊情况良好。此外，我们回顾了关于TTS患者MCS的文献（PubMed检索）。包括我们的患者在内，已有17例TTS诱发的心源性休克患者接受了MCS治疗的报道。患者年龄从16岁到74岁不等，71%为女性。体外膜肺氧合是最常用的MCS类型（82%的病例）。两名患者死亡，MCS的并发症很少见（1例腿部缺血）。理论上，降低前负荷且对后负荷无影响的MCS设备更可取。然而，由于缺乏随机试验，无法推荐特定类型的MCS。总之，我们的病例和现有文献表明，MCS治疗TTS诱发的难治性心源性休克是一种直接且可行的挽救生命的治疗方法。
