A Case of Recurrent Tako-tsubo Cardiomyopathy with Left Ventricular Outflow Tract Occlusion

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  • 左室流出路狭窄を伴った再発性たこつぼ型心筋症の一例
  • 症例報告 左室流出路狭窄を伴った再発性たこつぼ型心筋症の一例
  • ショウレイ ホウコク サシツ リュウシュツロ キョウサク オ トモナッタ サイハツセイタコツボガタ シンキンショウ ノ イチレイ

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Abstract

A 78 year-old female had a history of tako-tsubo cardiomyopathy two years ago. She was admitted to another hospital with prolonged chest pain after she felt mental stress at home. Abnormal electrocardiogram findings of ST elevation in leads V1-2 and slightly elevated troponin T were found. Coronary angiography revealed normal coronary arteries and multivessel coronary vasospasm by acetylcholine advocate test. Left vetriculography showed typical apical ballooning pattern with akinesis of the left ventricular apex and hyperkinesia of basal segments. Pullback of the catheter across the left ventricular outflow tract (LVOT) and aortic valve demonstrated a pressure gradient approaching 80 mmHg. Echocardiography showed severe obstruction of the LVOT and moderate mitral regurgitation due to a sigmoid septum with basal septal and obvious systolic anterior motion (SAM) of the mitral valve. Three weeks later, elective coronary angiography showed normal left ventricular function and a reduced outflow tract pressure gradient. This was a case of recurrent tako-tsubo cardiomyopathy with LVOT stenosis caused by sigmoid septum.

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