Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction--case report.
Apical ballooning syndrome complicated by acute severe mitral regurgitation with left ventricular outflow obstruction--case report.
复制标题
急性严重二尖瓣反流和左心室流出障碍物的急性严重二尖瓣反流的复杂性综合征。
DOI：
10.1186/1749-8090-2-14
复制
发表时间：
2007-02-21
影响因子：
1.6
通讯作者：
Wilson, Michael K.
中科院分区：
文献类型：
--
作者：
Chandrasegaram, Manju D.;Celermajer, David S.;Wilson, Michael K.
心尖气球综合征(或Takotsubo心肌病)是一种短暂的左心室心尖气球综合征。虽然最初在日本患者中描述，但现在在高加索人群中有很好的报道。该综合征类似于急性心肌梗死，但特点是没有梗阻性冠状动脉疾病。我们描述了一种严重但知之甚少的Takotsubo心肌病并发症。我们报告一位来自乡村医院的65岁女士，她因急性前壁心肌梗死而接受溶栓治疗。溶栓后4小时，她出现急性肺水肿和新的收缩期杂音。推测她有乳头肌破裂、缺血性功能障碍或急性室间隔缺损继发的急性二尖瓣反流。超声心动图显示严重的二尖瓣返流，左心室心尖气球扩张，二尖瓣收缩前移并有明显的左室流出道压差(60-70毫米汞柱)。冠状动脉造影术未发现阻塞性冠状动脉病变。她接受了主动脉内气囊反搏，但她危险的血流动力学状态没有改善。我们选择替换她的二尖瓣，以纠正二尖瓣流出道梯度和二尖瓣反流。术中二尖瓣轻度粘液瘤，但无结构异常。她接受了机械二尖瓣置换术，瓣膜直径29 mm。术后10天左室流出道梗阻消失，心功能恢复正常。她恢复得很好。此病例表现为严重且知之甚少的Takotsubo心肌病合并急性肺水肿、严重二尖瓣返流和二尖瓣收缩前移，并伴有严重的左室流出道梗阻。我们的病人的表现顺序表明，心尖气球扩张导致左心室几何改变，继而导致急性和严重的二尖瓣反流、二尖瓣收缩期前运动和左室流出道阻塞。采用机械二尖瓣置换术纠正左室流出道梗阻和二尖瓣返流。我们描述了一种变异型Takotsubo心肌病，伴有急性二尖瓣返流、二尖瓣瓣叶收缩期前运动和动态性质的左室流出道阻塞。
Apical ballooning syndrome (or Takotsubo cardiomyopathy) is a syndrome of transient left ventricular apical ballooning. Although first described in Japanese patients, it is now well reported in the Caucasian population. The syndrome mimicks an acute myocardial infarction but is characterised by the absence of obstructive coronary disease. We describe a serious and poorly understood complication of Takotsubo cardiomyopathy. We present the case of a 65 year-old lady referred to us from a rural hospital where she was treated with thrombolytic therapy for a presumed acute anterior myocardial infarction. Four hours after thrombolysis she developed acute pulmonary oedema and a new systolic murmur. It was presumed she had acute mitral regurgitation secondary to a ruptured papillary muscle, ischaemic dysfunction or an acute ventricular septal defect. Echocardiogram revealed severe mitral regurgitation, left ventricular apical ballooning, and systolic anterior motion of the mitral valve with significant left ventricular outflow tract gradient (60–70 mmHg). Coronary angiography revealed no obstructive coronary lesions. She had an intra-aortic balloon pump inserted with no improvement in her parlous haemodynamic state. We elected to replace her mitral valve to correct the outflow tract gradient and mitral regurgitation. Intra-operatively the mitral valve was mildly myxomatous but there were no structural abnormalities. She had a mechanical mitral valve replacement with a 29 mm St Jude valve. Post-operatively, her left ventricular outflow obstruction resolved and ventricular function returned to normal over the subsequent 10 days. She recovered well. This case represents a serious and poorly understood association of Takotsubo cardiomyopathy with acute pulmonary oedema, severe mitral regurgitaton and systolic anterior motion of the mitral valve with significant left ventricular outflow tract obstruction. The sequence of our patient's presentation suggests that the apical ballooning caused geometric alterations in her left ventricle that in turn led to acute and severe mitral regurgitation, systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction. The left ventricular outflow tract obstruction and mitral regurgitation were corrected by mechanical mitral valve replacement. We describe a variant of Takotsubo cardiomyopathy with acute mitral regurgitation, systolic anterior motion of the mitral valve leaflet and left ventricular outflow tract obstruction of a dynamic nature.
影响因子：
37.8
作者：
Sharkey, SW;Lesser, JR;Maron, BJ
通讯作者：
Maron, BJ
影响因子：
37.8
作者：
Brandspiegel, HZ;Marinchak, RA;Kowey, PR
通讯作者：
Kowey, PR
DOI：
10.1016/s0735-1097(01)01316-x
发表时间：
2001-07-01
影响因子：
24
作者：
Tsuchihashi, K;Ueshima, K;Morii, I
通讯作者：
Morii, I