Myocardial contrast echocardiography in the diagnosis of postoperative takotsubo myocardiopathy: case report and literature review

Jia-Hui Zeng,Feng-Juan Yao,Cui-Ling Li,Dong-Hong Liu,Min Ye,Rui Fan,Wei Li,Yan-Qiu Liu,Hong Lin

doi:10.1186/s12872-018-0985-z

Abstract

BackgroundTakotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period.Case presentationA 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment.ConclusionThis report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.

Highlights

Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress
This report presents a case of TCM in which Myocardial contrast echocardiography (MCE) was used to demonstrate intact microvascular perfusion despite apical akinesis
This report might support the use of MCE as a substitute for invasive coronary angiography

Summary

Background

Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that occurs in the absence of obstructive coronary artery disease (CAD) [1]. The echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle with depressed LV function (EF 36%),while basal segments’ movement were generally normal. Myocardial enzyme levels were elevated, the doctors did not perform treatment for coronary heart disease, considering the reason of tissue injury after heart surgery. A week later, the patient underwent coronary angiography, and the results showed no significant narrowing of the coronary artery. Echocardiography showed that the artificial mitral valve function and the segmental wall movement were normal, with an EF of 72%. The patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment

Discussion

Conclusion