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Heart failure and cardiomyopathies
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Left ventricular outflow tract obstruction in Takotsubo syndrome with cardiogenic shock: prognosis and treatment
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  • Published on: 19 November 2024
    Broadening the differential diagnosis of TTC-related mitral regurgitation

    Intriguingly, in the recent study, severe mitral regurgitation was present in as many as 10.3% of patients who did not have left ventricular outflow tract obstruction(LVOTO)[1]. This observation raises the question of whether or not mitral regurgitation(MR) might, in some of those cases, have been attributable to Takotsubo-related tethering of the mitral valve leaflets[2]. The latter was the underlying cause of severe MR in a 57 year old woman with previous history of treated hypertension who presented with chest pain and a blood pressure of 119/84 mm Hg. What we do not know is whether or not that blood pressure was her usual "on treatment" blood pressure or whether it represented a significant fall from her usual blood pressure. Her electocardiogram(ECG) showed ST segment elevation in leads V5 and V6. Coronary angiography did not show any obstructive lesion. Instead, she had stigmata of TTC, namely, apical left ventricular apical hypokinesis and basal hyperkinesis. Furthermore, she had eccentric mitral regurgitation associated with tethering of the anterior mitral leaflet. Neither LVOTO nor systolic anterior motion(SAM) of the mitral valve was observed. Her left ventricular ejection fraction(LVEF) amounted to 59.7%. After an uneventful clinical course she had a follow up which showed complete resolution of MR[2]. Leaflet tethering is believed also to be implicated in the aetiopathogenesis of TTC-related tricuspid regurgitation(TR)[3]. On occasions...

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    Conflict of Interest:
    None declared.