Anest. intenziv. Med. 2019;30(3-4):126-129

Takotsubo syndrome during thoracic spinal surgery. Case reportCelková anestezie - kazuistiky

V. Dostálová¹, T. Hosszú², M. Solař³, P. Dostál^1,*

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

² Neurochirurgická klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

³ I. interní kardioangiologická klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

Takotsubo cardiomyopathy (syndrome) is acute and reversible systolic dysfunction in the apical and middle areas combined with hypercontractility of the basal segment of the left ventricle. The clinical presentation of Takotsubo is similar to that of an acute coronary syndrome and myocardial infarction with ST elevation and cardiac enzyme rise. Coronarography is negative. Takotsubo cardiomyopathy affects especially postmenopausal women and the main trigger is severe psychological stress. Recently, several case reports described the onset of Takotsubo cardiomyopathy intraoperatively in patients undergoing thoracic spine surgery. We report the case of a 71-year old female developing severe haemodynamic instability and ST segment elevation during thoracic spinal surgery for haemangioma. There was a disorder of the basal and lateral wall kinetics of the left ventricle on the postoperative echocardiogram and negative coronarography. Cardiac catheterization confirmed absence of any critical coronary disease but presence of typical apical ballooning and midventricular hypokinesis with ejection fraction of the left ventricle of 36% on ventriculography. Troponin T reached maximal levels on the first postoperative day (781 ng/l). The kinetics of the left ventricle normalized and the stabilisation of the thoracic spine was completed without any others complications after 21 days of conservative therapy.

Keywords: Takotsubo cardiomyopathy; Takotsubo syndrome; thoracic spinal surgery; acute coronary syndrome

Received: May 15, 2019; Accepted: May 24, 2019; Published: June 1, 2019  Show citation