Enseleit, Frank

Ruschitzka, Frank

Stähli, Barbara E.

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CARDIOVASCULAR FLASHLIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .doi:10.1093/eurheartj/ehr079Online publish-ahead-of-print 28 March 2011Isolated right ventricular ballooning syndrome: a new variant of transientcardiomyopathyBarbara E. Sta¨hli , Frank Ruschitzka, and Frank Enseleit*Cardiovascular Center, Department of Cardiology, University Hospital Zu¨rich, Ra¨mistrasse 100, 8091 Zu¨rich, Switzerland* Corresponding author. Tel: +41 44 255 58 42, Fax: +41 44 255 48 59, Email: frank.enseleit@usz.chThis paper was guest edited by Prof. Frank E. Rademakers, University Hospital Gasthuisberg, Leuven, BelgiumWe describe the first case of an isolated rightventricular (RV) ‘Tako-Tsubo’ cardiomyopathy. A68-year-old woman was referred to the intensivecare unit (ICU) due to acute right heart failureoccurring after laparoscopic abdominal wall herniarepair. New T-wave inversions were documentedin leads V2–V4 and V3R–V5R (Panels B and C),and troponin T (0.46 ng/mL) was elevated. Coron-ary angiography was completely normal. Echocar-diography revealed a severely dilated RV (end-diastolic area ¼ 27 cm2) with reduced fractionalarea change (fac ¼ 17%) and reduced longitudinalshortening (tricuspid annular motion ¼ 16 mm).Moreover, the right mid-ventricular lateral wallwas hypokinetic, whereas left ventricular ejectionfraction was fully preserved (Panels D and E; seeSupplementary material online, Videos S1 and S2).Echocardiography did not support the diagnosis ofarrhythmogenic RV cardiomyopathy. Any pulmon-ary or abdominal pathology as potential cause for volume or pressure elevation was excluded by thoraco-abdominal computed tom-ography. Follow-up echocardiography 3 days later revealed completely normal RV size and function. Treatment consisted ofintravenous fluid resuscitation, vasopressors, and inotropic drugs, and the patient fully recovered and could be discharged fromthe ICU 6 days after admission.‘Tako-Tsubo’ cardiomyopathy is an acute cardiac syndrome characterized by transient wall-motion abnormalities, typically involvingthe left ventricular apex. Indeed, apical-sparing mid-ventricular variants have been described, and biventricular involvement is observedin approximately one-third of the patients. However, isolated RV involvement as reported in our patient has not been documentedso far. Thus, isolated RV involvement may represent a distinct manifestation of ‘Tako-Tsubo’ cardiomyopathy, and the pattern of leftventricular wall-motion abnormalities itself may not be pathognomonic for the diagnosis.Panels A–C. Electrocardiography: (A) Preoperative electrocardiography showing normal sinus rhythm without any repolarizationabnormalities. (B) New T-wave inversions in leads V2–V4 and (C ) V3R–V5R on admission.Panels D and E. Right ventricular dilatation on admission. (D) End-diastolic apical four-chamber view. (E) End-diastolic parasternalshort-axis view.Supplementary materialSupplementary material is available at European Heart Journal online.Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2011. For permissions please email: journals.permissions@oup.com.Cardiovascular flashlight 1821

Isolated right ventricular ballooning syndrome: a new variant of transient cardiomyopathy

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