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乙状隔：应激性心肌病左心室流出道梗阻的旁观者还是参与者？—— 1例病例报告及文献复习

Sigmoid Septum: A Bystander or Contributor to a Left Ventricular Outflow Tract Obstruction in Takotsubo Syndrome - A Case Report with a Literature Review.

作者信息

Atanasković Marko, Mihajlović Bojan, Stefanović Maja, Bjelobrk Marija, Crnomarković Branislav, Kovačević Mila

机构信息

University of Novi Sad, Faculty of Medicine, Serbia.

Institute for Cardiovascular Diseases of Vojvodina, Serbia.

出版信息

Intern Med. 2025 Sep 1;64(17):2557-2573. doi: 10.2169/internalmedicine.4489-24. Epub 2025 Feb 22.

DOI:10.2169/internalmedicine.4489-24
PMID:39993754
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12463423/
Abstract

Approximately 20% of patients with Takotsubo syndrome (TTS) develop complications such as left ventricular outflow tract obstruction (LVOTO). The published data suggest that a significant proportion of these patients have predisposing septal hypertrophy or sigmoid septum. However, the pathophysiology regarding this connection has not yet been fully elucidated. We herein present the case of a 75-year-old female patient with TTS complicated by LVOTO, which was successfully managed. During the follow-up, mild basal septal hypertrophy was observed. Subsequent exercise and dobutamine stress echocardiography were performed to reveal the mechanism of LVOTO in TTS.

摘要

约20%的应激性心肌病（TTS）患者会出现诸如左心室流出道梗阻（LVOTO）等并发症。已发表的数据表明，这些患者中有很大一部分存在易患性的室间隔肥厚或乙状结肠样室间隔。然而，关于这种关联的病理生理学尚未完全阐明。我们在此介绍一例75岁女性TTS患者并发LVOTO且成功治疗的病例。随访期间，观察到轻度的基底室间隔肥厚。随后进行运动和多巴酚丁胺负荷超声心动图检查以揭示TTS中LVOTO的机制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/7c679f19877a/1349-7235-64-17-2557-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/5d20d16f1ab4/1349-7235-64-17-2557-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/9d60603081aa/1349-7235-64-17-2557-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/a0b41d4af886/1349-7235-64-17-2557-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/60f4ebf27a20/1349-7235-64-17-2557-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/3aa47875d8ad/1349-7235-64-17-2557-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/20168b5dec99/1349-7235-64-17-2557-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/de1f0a15701b/1349-7235-64-17-2557-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/e324170bca0e/1349-7235-64-17-2557-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/7c679f19877a/1349-7235-64-17-2557-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/5d20d16f1ab4/1349-7235-64-17-2557-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/9d60603081aa/1349-7235-64-17-2557-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/a0b41d4af886/1349-7235-64-17-2557-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/60f4ebf27a20/1349-7235-64-17-2557-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/3aa47875d8ad/1349-7235-64-17-2557-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/20168b5dec99/1349-7235-64-17-2557-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/de1f0a15701b/1349-7235-64-17-2557-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/e324170bca0e/1349-7235-64-17-2557-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4725/12463423/7c679f19877a/1349-7235-64-17-2557-g009.jpg

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本文引用的文献

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Acute Left Ventricular Ballooning: Tools to Differentiate Hypertrophic Cardiomyopathy with Outflow Obstruction from Neurohumoral Takotsubo Syndrome.急性左心室气球样变：鉴别肥厚型心肌病伴流出道梗阻与神经体液性应激性心肌病的工具
Rev Cardiovasc Med. 2023 May 19;24(5):154. doi: 10.31083/j.rcm2405154. eCollection 2023 May.
2
Left ventricular outflow tract obstruction/hypertrophic cardiomyopathy/takotsubo syndrome: A new hypothesis of takotsubo syndrome pathophysiology.左心室流出道梗阻/肥厚型心肌病/心尖球形综合征：心尖球形综合征病理生理学的新假说。
Curr Probl Cardiol. 2024 Aug;49(8):102668. doi: 10.1016/j.cpcardiol.2024.102668. Epub 2024 May 24.
3
Extracellular Volume Analysis Using Computed Tomography Is Useful for Follow-up of Takotsubo Syndrome.
使用计算机断层扫描进行细胞外容积分析对Takotsubo综合征的随访有用。
Circ J. 2024 Jun 25;88(7):1198. doi: 10.1253/circj.CJ-24-0139. Epub 2024 Apr 27.
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An update on the mechanisms of Takotsubo syndrome: "At the end an acute coronary syndrome".心肌顿抑综合征发病机制的最新研究进展：“急性冠脉综合征的终章”。
J Mol Cell Cardiol. 2024 Jun;191:1-6. doi: 10.1016/j.yjmcc.2024.04.009. Epub 2024 Apr 18.
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Intra-Aortic Balloon Pump Exacerbates Left Ventricular Outflow Tract Obstruction in a Patient With Takotsubo and Hypertrophic Cardiomyopathy.主动脉内球囊反搏加重了一名患有应激性心肌病和肥厚型心肌病患者的左心室流出道梗阻。
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