待機的僧帽弁置換後にたこつぼ心筋症が疑われた1例

Suspected Takotsubo Cardiomyopathy after Elective Mitral Valve Replacement：Report of a Case

はじめに　心臓手術後にたこつぼ心筋症（TC）を発症することはまれである．われわれは，僧帽弁置換術後急性期にTCが強く疑われた症例を経験したので，文献的考察を加えて報告する．

Reports of takotsubo cardiomyopathy following cardiac surgery are rare. We report a case of postoperative takotsubo cardiomyopathy after mitral valve replacement （MVR）. The patient was a 70-year-old woman with mitral stenosis, regurgitation, and a medical history of long-standing persistent atrial fibrillation. Preoperative echocardiogram confirmed severe mitral regurgitation, severe mitral stenosis, severe tricuspid regurgitation, and slight left ventricular dysfunction. Coronary lesions were not observed on preoperative diagnostic coronary angiography. MVR with a bioprosthetic valve, tricuspid annuloplasty, and left atrial maze were performed. Electrocardiogram on postoperative day （POD） 1 revealed a deep negative T wave in V3-V6. Echocardiogram revealed “takotsubo-like” wall motion, and the ejection fraction （EF） was 19％. The EF improved on POD 7. After three months, the electrocardiogram findings and EF appeared normal. We suspected takotsubo cardiomyopathy although postoperative coronary angiography was not performed. Takotsubo cardiomyopathy should be considered as a possible complication of cardiac surgery, especially after MVR.