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European Journal of Echocardiography Advance Access originally published online on January 5, 2007
European Journal of Echocardiography 2008 9(3):384-385; doi:10.1016/j.euje.2006.11.011
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Subaortic dynamic obstruction: a contributing factor to haemodynamic instability in tako-tsubo syndrome?

Adrian Ionescu*

Morriston Cardiac Centre, Swansea SA6 6NL, UK

Received 21 September 2006; accepted after revision 26 November 2006; online publish-ahead-of-print 5 January 2007.

* Corresponding author. Tel: +44 01792703195; fax: +44 01792703522. E-mail address: adrian.ionescu{at}swansea-tr.wales.nhs.uk


  Abstract

We present a case of transient apical ballooning with haemodynamic instability in a female patient with normal coronaries and a history of poorly controlled systemic arterial hypertension. There was dynamic obstruction of the outflow tract and moderate secondary mitral regurgitation at presentation. These were due to systolic anterior motion of the mitral valve, which normalised gradually with the recovery of left ventricular function, and to a ‘sigmoid’ septum. Mid-cavity obstruction is potentially an important contributory factor to the haemodynamic instability sometimes encountered in this syndrome.

Keywords: Apical ballooning; Sigmoid septum; Dynamic mitral regurgitation


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