Takotsubo syndrome after palliative transcatheter treatment of acquired aortic stenosis in patient with congenital ventricular septal defect. Case report

Cover Page

Cite item

Full Text

Abstract

The authors report the clinical case of secondary Takotsubo syndrome developed after transcatheter aortic valve replacement that was performed in compassionate manner in female patient with combination of congenital ventricular septal defect and acquired severe aortic stenosis. In the team’s view, Takotsubo syndrome was triggered with profound changes of intracardial hemodynamics subsequent to iatrogenic impairment of preexisting interventricular shunt.

About the authors

Alexey E. Komlev

Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology

Author for correspondence.
Email: pentatonika@bk.ru
ORCID iD: 0000-0001-6908-7472

кардиолог отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

Marina D. Muksinova

Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0001-6516-5322

кардиолог отд. сердечной недостаточности и заболеваний миокарда

Russian Federation, Moscow

Marina A. Saidova

Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0002-3233-1862

д-р мед. наук, проф., рук. отд. ультразвуковых методов исследования

Russian Federation, Moscow

Ella V. Kurilina

Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0002-3208-534X

врач-патологоанатом, зав. патологоанатомическим отд-нием

Russian Federation, Moscow

Timur E. Imaev

Myasnikov Institute of Clinical Cardiology, National Medical Research Center of Cardiology

Email: pentatonika@bk.ru
ORCID iD: 0000-0002-5736-5698

д-р мед. наук, сердечно-сосудистый хирург, гл. науч. сотр. отд. сердечно-сосудистой хирургии

Russian Federation, Moscow

References

  1. Prasad A, Dangas G, Srinivasan M, et al. Incidence and angiographic characteristics of patients With apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial. Cathet Cardiovasc Intervent. 2013;83(3):343-8. doi: 10.1002/ccd.23441
  2. Bybee K, Prasad A, Barsness G, et al. Clinical characteristics and Thrombolysis In Myocardial Infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol. 2004;94(3):343-6. doi: 10.1016/j.amjcard.2004.04.030
  3. Redfors B, Vedad R, Angerås O, et al. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction – A report from the SWEDEHEART registry. Int J Cardiol. 2015;185:282-9. doi: 10.1016/j.ijcard.2015.03.162
  4. Templin C, Ghadri J, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929-38. doi: 10.1056/nejmoa1406761
  5. Y-Hassan S. Clinical features and outcome of epinephrine-induced takotsubo syndrome: Analysis of 33 published cases. Cardiovasc Revasc Med. 2016;17(7):450-5. doi: 10.1016/j.carrev.2016.07.005
  6. Abraham J, Mudd J, Kapur N, et al. Stress Cardiomyopathy After Intravenous Administration of Catecholamines and Beta-Receptor Agonists. J Am Coll Cardiol. 2009;53(15):1320-5. doi: 10.1016/j.jacc.2009.02.020
  7. Ansari U, El-Battrawy I, Fastner C, et al. Clinical outcomes associated with catecholamine use in patients diagnosed with Takotsubo cardiomyopathy. BMC Cardiovasc Disord. 2018;18(1). doi: 10.1186/s12872-018-0784-6
  8. Mitchell A, Marquis F. Can takotsubo cardiomyopathy be diagnosed by autopsy? Report of a presumed case presenting as cardiac rupture. BMC Clin Pathol. 2017;17(1). doi: 10.1186/s12907-017-0045-0
  9. Manes A, Palazzini M, Leci E, et al. Current era survival of patients with pulmonary arterial hypertension associated with congenital heart disease: a comparison between clinical subgroups. Eur Heart J. 2013;35(11):716-24. doi: 10.1093/eurheartj/eht072
  10. Galiè N, Humbert M, Vachiery J, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2015;37(1):67-119. doi: 10.1093/eurheartj/ehv317
  11. Prasad A, Lerman A, Rihal C. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): A mimic of acute myocardial infarction. Am Heart J. 2008;155(3):408-17. doi: 10.1016/j.ahj.2007.11.008
  12. Ghadri J, Wittstein I, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018;39(22):2032-46. doi: 10.1093/eurheartj/ehy076
  13. Harhash A, Koulogiannis K, Marcoff L, et al. Cardiomyopathy After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2016;9(12):1302-4. doi: 10.1016/j.jcin.2016.04.017
  14. Floras J, Ponikowski P. The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction. Eur Heart J. 2015;36(30):1974-82. doi: 10.1093/eurheartj/ehv087
  15. Madias J. Cardiac arrest-triggered takotsubo syndrome vs. takotsubo syndrome complicated by cardiac arrest. Int J Cardiol. 2016;225:142-3. doi: 10.1016/j.ijcard.2016.09.090
  16. Madias C, Fitzgibbons T, Alsheikh-Ali A, et al. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm. 2011;8(4):555-61. doi: 10.1016/j.hrthm.2010.12.012
  17. Migliore F, Zorzi A, Perazzolo Marra M, et al. Myocardial edema as a substrate of electrocardiographic abnormalities and life-threatening arrhythmias in reversible ventricular dysfunction of takotsubo cardiomyopathy: Imaging evidence, presumed mechanisms, and implications for therapy. Heart Rhythm. 2015;12(8):1867-77. doi: 10.1016/j.hrthm.2015.04.041
  18. Gili S, Cammann V, Schlossbauer S, et al. Cardiac arrest in Takotsubo syndrome: results from the InterTAK Registry. Eur Heart J. 2019;40(26):2142-51. doi: 10.1093/eurheartj/ehz170
  19. Lyon A, Bossone E, Schneider B, et al. Current state of knowledge on Takotsubo syndrome: А Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2015;18(1):8-27. doi: 10.1002/ejhf.424

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Electrocardiogram on admission.

Download (228KB)
Indexing metadata
3. Fig. 2. Echocardiography (EchoCG) on admission. High intraventricular septum defect (indicated by the arrow) with determining the ratio of pulmonary and systemic blood flow.

Download (272KB)
Indexing metadata
4. Fig. 3. Multispiral computed tomography of the heart with intravenous contrast. The arrow indicates the defect in the membranous part of interventricular septum.

Download (120KB)
Indexing metadata
5. Fig. 4. Coronary angiogram: a – left coronary artery; b – right coronary artery (arrow indicates stenosis of the right coronary artery).

Download (301KB)
Indexing metadata
6. Fig. 5. Final intraoperative aortography. A self-expanding aortic valve prosthesis is installed in the aortic position.

Download (237KB)
Indexing metadata
7. Fig. 6. EchoCG after surgery. Akinesis in the mid- and apical segments of left ventricle (LV): a – diastole; b – systole.

Download (109KB)
Indexing metadata
8. Fig. 7. Coagulative myocardial necrosis zone without a marked demarcation shaft, with a sharp expansion and plethora of vessels in the border area. Staining with hematoxylin and eosin. ×100.

Download (357KB)
Indexing metadata
9. Fig. 8. Diffuse myocardial stromal edema with mucoidization. Diffuse moderate lymphocytic-macrophage infiltration of the stroma. Focal myocytolysis. Hypertrophy of cardiomyocytes. Staining with hematoxylin and eosin. ×200.

Download (354KB)
Indexing metadata
10. Fig. 9. Focal lymphocytic infiltration in the myocardial stroma. Myocardial stromal edema. Coagulative necrosis of certain groups of cardiomyocytes. Hypertrophy of cardiomyocytes. Expansion and plethora of venous vessels. Sludge phenomenon. Staining with hematoxylin and eosin. ×200.

Download (324KB)
Indexing metadata
11. Fig. 10. Area of cardiosclerosis with loosening and edema of fibrous tissue, diffuse lymphohistiocytic infiltration. Pronounced stromal edema. Capillary congestion. Coagulative necrosis of individual cardiomyocytes. Hypertrophy of cardiomyocytes. Staining with hematoxylin and eosin. ×200.

Download (432KB)
Indexing metadata
12. Fig. 11. Emphasized transverse striation of cardiomyocytes in the apical part of left ventricle. Myocardial stromal edema. Staining with hematoxylin and eosin. ×400.

Download (335KB)
Indexing metadata

Copyright (c) 2021 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies