Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVI/271: 036-041 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVI/271: 036-041

Title: Takotsubo syndrome following mitral valve replacement and left anterior descending coronary artery bypass grafting 

Authors: Elikowski W, Małek-Elikowska M, Greberski K, Rzymski S, Kołowrotkiewicz A, Furmaniuk J, Bugajski P.

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Takotsubo syndrome following mitral valve replacement and left anterior descending coronary artery bypass grafting

Elikowski W1, Małek-Elikowska M2, Greberski K3, Rzymski S4, Kołowrotkiewicz A4, Furmaniuk J5, Bugajski P3.

Józef Struś Hospital, Poznań, Poland: 1Department of Internal Medicine; 3Department of Cardiac Surgery, 4Department of Anesthesiology and Intensive Therapy; 22nd Department of Cardiology, Poznań University of Medical Sciences, Poland; 5Department of Invasive Cardiology and Internal Medicine, Regional Hospital, Poznań, Poland

Takotsubo syndrome (TTS) is rarely diagnosed following valvular and nonvalvular cardiac surgery. Only several such cases, including 12 after mitral valve replacement (MVR) or plasty (MVP) and 2 after coronary artery bypass grafting (CABG) have been reported so far.
A case report
. The authors describe a case of a 75-year-old female in whom TTS occurred on the first postoperative day after elective combined surgery: MVR (with bioprosthesis) and CABG (of the left anterior descending coronary artery). Echocardiography revealed left ventricular (LV) dysfunction in the form of apical ballooning with markedly decreased ejection fraction (EF) and global longitudinal strain (GLS): 28 % and -9.3 %, respectively; there were no signs of prosthesis dysfunction. Due to circulatory and concomitant respiratory failure, she was transferred to the intensive care unit; however, an intra-aortic balloon pump was not necessary. Normalization of LV function (EF 60%, GLS -18.5%) was observed after 2 weeks. The authors compare the clinical data of the case presented with those of the remaining 14 TTS patients after MVR, MVP or CABG described in the literature and emphasize the coexistence of multiple triggering factors (e.g. additional procedures, catecholamines use, protamine use, pleural or pericardial drainage, blood transfusion, rapid heart rate). The authors suggest that TTS should be routinely included in differential diagnosis of post-cardiac surgery heart failure decompensation.

Key words: takotsubo syndrome, apical ballooning, mitral valve replacement, coronary artery bypass grafting, cardiac surgery, concomitant coronary artery disease

Pol Med J, 2019; XLVI (271); 36–41