title: Takotsubo Cardiomyopathy Following Cardiac Surgery.
abstract: BACKGROUND
  Takotsubo cardiomyopathy syndrome, commonly occurring in postmenopausal women, is characterized by transient apical systolic dysfunction in absence of coronary lesions. The cardiomyopathy is often observed after intense stressful events such as a major surgical procedure.
  
  
  METHODS
  A 72-year-old woman symptomatic for dyspnea at rest, chest pain, and peripheral edema successfully underwent surgery for noncoronary sinus aneurysm-right atrium fistula repair. Two days after surgery the patient developed takotsubo syndrome, diagnosed according to the Mayo Clinic criteria. We reviewed the literature on takotsubo cardiomyopathy as a complication of major cardiac surgery procedures.
  
  
  RESULTS
  Takotsubo cardiomyopathy is confirmed as a possible early complication of cardiac surgery. Exaggerated sympathetic stimulation may cause massive endogenous catecholamine release. Hypoperfusion during cardiopulmonary bypass, inotropic drugs administration, and postoperative anxiety and pain are all factors generating stress, possible coronary artery spasm and transient cardiomyopathy, clinically simulating acute myocardial infarction. Several clinical features have been described such as acute mitral insufficiency, systolic anterior motion of the anterior mitral valve leaflet, left ventricular outflow tract obstruction, acute cardiac failure, and cardiogenic shock. Intraventricular thrombi and adverse cerebrovascular events may also be possible complications. Rare catastrophic events such as left ventricular free wall rupture and ventricular septal perforation have been also encountered.
  
  
  CONCLUSIONS
  After cardiac surgery takotsubo cardiomyopathy should be suspected if clinical and instrumental criteria are met, and promptly differentiated from the more frequent acute myocardial infarction. Prognosis may be favorable if appropriate conservative medical treatment is promptly started.
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of The Sacred Heart, Agostino Gemelli Policlinic, Rome, Italy.
authors.forename: Giovanni Alfonso
authors.initials: GA
authors.lastname: Chiariello
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of The Sacred Heart, Agostino Gemelli Policlinic, Rome, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Bruno
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of The Sacred Heart, Agostino Gemelli Policlinic, Rome, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Colizzi
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of The Sacred Heart, Agostino Gemelli Policlinic, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.affiliation: Department of Cardiovascular Sciences, Catholic University of The Sacred Heart, Agostino Gemelli Policlinic, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Massetti
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D002395:Catecholamines / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D005402:Fistula / Q000601:surgery; D006322:Heart Aneurysm / Q000601:surgery; D006325:Heart Atria; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011379:Prognosis; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*
chemical_list: D002395:Catecholamines