eComment: Re: Takotsubo cardiomyopathy after elective mitral valve replacement.

LV systolic function, heavily compromised at presentation, improves rapidly in a period of days to weeks w1, 5–7x. Reports of Takotsubo syndrome after open cardiac surgery are few. It is possible that some cases of transient LV sphericalization after mitral valve replacement surgery described previously to the recognition of this phenomenon were cases of Takotsubo syndrome w2x. It is important to consider Takotsubo syndrome in the differential diagnosis of patients presenting cardiogenic shock after cardiac surgery. Dyskinetic apical and mid-ventricular segments with concomitant hyperdynamic basal segments may result in hemodynamically significant dynamic left ventricular intracavitary obstruction w1, 7, 8x. Hemo-dynamic impairments in this situation require significantly different management from that needed for hypotension due to pure pump failure. In this special hemodynamic situation, it is recommended the administration of beta-blockers to increase diastolic ventricular filling time and left ventricular end-diastolic volume, administration of phenylephrine to increase afterload with subsequent reduction of the intraventricular gradient, and administration of fluid resuscitation if pulmonary congestion is not present. CS. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics ST-segment elevation myocardial infarction. due to simultaneous multivessel coronary spasms: a review of 5 cases. ballooning syndrome or Takotsubo cardiomyopathy: a systematic review. Stress cardiomyopathy is a novel clinical syndrome affecting predominantly elderly female patients. The authors describe one of the first cases of Takotsubo cardiomyopathy after elective mitral valve replacement w1x. Clinical and diagnostic aspects accumulated and described in this article are important for understanding the pathophysiology of this disorder. Our data show that this pathology concerns 1% of individuals with suspected acute myocardial infarction w2x. Among the patients with Takotsubo cardiomyopathy the left ventricular dysfunction is likely to recover rapidly, but the management of implications (contrary to atherosclerotic myocardial infarction/ischemia) are likely different. Although different complications (17%, 109/625), such as dysrhythmias (39%, 32/82), heart failure (50%, 41/ 82), and even cardiogenic shock (23%, 18/40 with acute heart failure) occurred, the prognosis appeared to be much better w2x. Moreover, some patients required intravenous dopamine or dobutamine infusion and mechanical supports, including a percutaneous cardiopulmonary support system. Although almost all patients with this syndrome were reported to have a favorable prognosis (mean period of recovery 11"1 days w2x, EF (on admission) 41.3"1.9% vs. EF (recovery) 63.6"1.0% (Ps0.000) w2x), careful clinical observation for critical complications or recurrences is recommended, especially after cardiovascular interventions, as described in the presented case w1x. In our clinic, we …