Setozaki Shuji, Hamuro Mamoru, Yamamoto Kenji, Enomoto Sakae
Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan.
Kyobu Geka. 2021 May;74(5):358-361.
Reports of takotsubo cardiomyopathy following cardiac surgery are rare. We report a case of postoperative takotsubo cardiomyopathy after mitral valve replacement (MVR). The patient was a 70-yearold woman with mitral stenosis, regurgitation, and a medical history of long-standing persistent atrial fibrillation. Preoperative echocardiogram confirmed severe mitral regurgitation, severe mitral stenosis, severe tricuspid regurgitation, and slight left ventricular dysfunction. Coronary lesions were not observed on preoperative diagnostic coronary angiography. MVR with a bioprosthetic valve, tricuspid annuloplasty, and left atrial maze were performed. Electrocardiogram on postoperative day (POD) 1 revealed a deep negative T wave in V3-V6. Echocardiogram revealed "takotsubo-like" wall motion, and the ejection fraction( EF) was 19%. The EF improved on POD 7. After three months, the electrocardiogram findings and EF appeared normal. We suspected takotsubo cardiomyopathy although postoperative coronary angiography was not performed. Takotsubo cardiomyopathy should be considered as a possible complication of cardiac surgery, especially after MVR.
心脏手术后发生应激性心肌病的报道很少见。我们报告一例二尖瓣置换术（MVR）后发生的术后应激性心肌病病例。该患者为一名70岁女性，患有二尖瓣狭窄、反流，并有长期持续性心房颤动病史。术前超声心动图证实存在严重二尖瓣反流、严重二尖瓣狭窄、严重三尖瓣反流及轻度左心室功能障碍。术前诊断性冠状动脉造影未观察到冠状动脉病变。实施了生物瓣膜二尖瓣置换术、三尖瓣环成形术及左心房迷宫手术。术后第1天（POD 1）心电图显示V3-V6导联T波深倒置。超声心动图显示“应激性心肌病样”室壁运动，射血分数（EF）为19%。POD 7时EF有所改善。三个月后，心电图表现及EF恢复正常。尽管未进行术后冠状动脉造影，但我们怀疑为应激性心肌病。应激性心肌病应被视为心脏手术尤其是MVR术后可能出现的并发症。
