Cardiovascular Anesthesia
Online ISSN : 1884-7439
Print ISSN : 1342-9132
ISSN-L : 1342-9132
Takotsubo cardiomyopathy diagnosed after noncardiac surgery in a very elderly patient with severe aortic stenosis: a case report
Mitsuyoshi YoshidaRyuichi KawataRisa UchiYuji MoriKaori HirayamaTakao OshibuchiKenji Ohki
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JOURNAL FREE ACCESS

2016 Volume 20 Issue 1 Pages 47-51

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Abstract

 A 98-year-old woman with dementia was admitted with a left femoral trochanteric fracture. Transthoracic echocardiography on admission revealed severe aortic stenosis (aortic valve mean pressure gradient of 55 mmHg, peak aortic jet velocity of 4.87 m/s) with normal ventricular systolic function. Internal fixation was planned 4 days after admission. Chest X-ray findings immediately before the operation indicated slightly worsened cardiomegaly with increased pulmonary vascular shadow. In the operating room, lumbar plexus block and sacral plexus block were performed under real-time ultrasound guidance with nerve stimulation, and a mixture of 7.5 ml ropivacaine 0.75% and 7.5 ml lidocaine 2% was injected for each block. The intraoperative course was uneventful, but chest X-ray on postoperative day 1 revealed severe pulmonary congestion and bilateral pulmonary effusion. There was also new T-wave inversion on the electrocardiogram and modest elevation of cardiac troponin I. Transthoracic echocardiography was immediately performed, revealing reduced left ventricular ejection fraction with akinesis of the mid to apical walls that extended beyond a single epicardial vascular distribution. Although coronary angiography was not performed, the findings strongly suggested Takotsubo cardiomyopathy (TCM), and conservative therapy was given. A few weeks later, the ventricular function returned to normal, and the diagnosis of TCM was confirmed. It is possible that not only the femoral fracture itself but also inadequate stress regression during surgery may have been triggers of TCM. It is not clear whether TCM occurred before, during or after surgery, but a thorough examination for potential preoperative heart failure was required.

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© 2016 Japanese Society of Cardiovascular Anesthesiologists
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