Takotsubo cardiomyopathy following pericardiectomy: A case report

Abstract

Background Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle's apical area resembling myocardial infarction in the nonexistence of coronary artery disease. Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aim To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and Methods A 66‐year‐old man underwent a pericardiectomy. He progressed to exacerbation of hemodynamic instability postoperatively and was diagnosed with TC, finally, he had to be supported by an intra‐aortic balloon pump (IABP), extracorporeal membrane oxygenation (ECMO). Results Patient's left ventricle function recovered fully in 2 weeks. Discussion We discussed the pathogenesis and treatment of postoperative TC. Conclusion TC has to be carefully considered in the differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery.

Anesthesia/surgery‐triggered takotsubo syndrome: A dearth of specific knowledge on its pathophysiology and therapy

“…To the Editor, I enjoyed reading the report by Zhang and Liao, 1 about the 66-yearold man with tuberculous constrictive pericarditis, who suffered takotsubo syndrome (TTS), after undergoing pericardiectomy. There is no doubt that a dearth of knowledge about the exact pathophysiology of TTS in general, and the special case of TTS triggered by anesthesia and/or surgery continues to plague us.…”

“…The authors have done a good job in pointing out the noxious effects of anesthesia and or surgical stress imparting a host of circulatory and metabolic derangements, the rise of catecholamines, associated with the perianesthetic and perioperative period, and further listing all the commonly employed plausible speculations about the still evasive pathophysiology of TTS. I have some questions and remarks for the kind consideration by the authors: (1) The patient received postoperatively small amounts of norepinephrine (NE) to manage his mild hypotension, with larger doses of this drug given later when the patient's hypotension worsen; it is conceivable that TTS was triggered by the NE infusion, and thus details about the amount given, the rate of infusion, and duration for NE and all the other drugs the patient received perioperatively will be useful. (2) The authors were surprised by the early maintenance of a good left ventricular ejection fraction (LVEF) while there were already regional wall motion abnormalities present, and before the sudden drop of the LVEF, but this is probably due to the rare opportunity the authors had, to see TTS newly emerging under their eyes, a rare occurrence.…”

Postcardiac surgery Takotsubo cardiomyopathy: No longer a surprise

“…Zhang et al 1 recently reported an interesting case of Takotsubo cardiomyopathy (TC) following pericardiectomy. TC after cardiac operations is is rare, being encountered in most cases, after mitral valve surgery.…”