Mitral valve replacement and Takotsubo syndrome

Abstract

Athanasiou et al. [1] should be commended for their seminal review on evidence synthesis and critical reappraisal of surgical techniques of preservation of mitral subvalvar apparatus. However, when Lillehei and colleagues in the early 1960s had proposed the chordal-sparing technique of mitral valve replacement (MVR), the entity of Takotsubo syndrome had not been described. Nearly 30 years later, Satoh et al. [2], Dote and colleagues [3] from Japan described in 1990 and 1991 this novel syndrome, characterized by transient reversible left ventricular (LV) dysfunction in the absence of coronary artery disease, with chest pain, electrocardiographic changes mimicking acute anterior myocardial infarction, but only minimal release of myocardial enzymes. Left ventriculograms revealedapeculiar shapeof theLVresembling aTakotsubo [the type of bottle with a round bottom and narrow neck — used in Japan for trapping octopus]. The syndrome is also known as acute left ventricular ballooning, transient apical ballooning, ampulla cardiomyopathy and because stress has been implicated in its pathophysiology. Human stress cardiomyopathy or broken-heart syndrome. We have earlier described the occurrence of Takotsubo syndrome in a patient after mitral valve replacement [4]. Diagnostic criteria for Takotsubo syndrome, viz. (a) new electrocardiographic abnormalities; either STelevations or T wave inversion, (b) absence of obstructive coronary artery disease, and (c) transient akinesia or dyskinesia of the left ventricle, etc. have been described [5]. Despite the characteristic, near pathognomonic pattern of LV wall motion abnormalities and the typical course of the syndrome, the clinician needs to differentiate it from three