Skip to main content
European Heart Journal. Case Reports logoLink to European Heart Journal. Case Reports
. 2020 Nov 9;4(6):1–2. doi: 10.1093/ehjcr/ytaa384

Takotsubo syndrome following MitraClip procedure

Takehiro Nomura 1, Yoshiko Munehisa 1, Masaki Nakashima 1, Takashi Matsumoto 1,
Editors: Luigi Biasco, Calik Ali Nazmi, Sarathy Kiran
PMCID: PMC7891285  PMID: 33634224

An 87-year-old man underwent a successful MitraClip (Abbott Vascular, Santa Clara, CA, USA) procedure for severe mitral regurgitation (MR) due to P3 prolapse with general anaesthesia and transoesophageal echocardiography guidance. The next morning, he complained of chest pain. Transthoracic echocardiography (TTE) demonstrated new severe apical akinesis without worsening of the MR (Figure 1). Angiography revealed akinesis of the apex of the left ventricle with no coronary artery obstruction (Video 1), consistent with the diagnosis of takotsubo syndrome. The subsequent clinical course was uneventful, without elevation of cardiac enzymes (maximum creatine kinase 112 U/L). On postoperative day 6, TTE demonstrated normalization of the left ventricular apical wall motion, and the patient was discharged home.

Figure 1.

Figure 1

Left ventricular angiography. The figure shows left ventricular angiography in diastole (A) and systole (B). It reveals akinesis of the apex of the left ventricle with concomitant basal hyperkinesis.

The onset of takotsubo cardiomyopathy is often proceeded by emotional or physical stress including open-heart surgery.1 Although the supporting evidence is limited, catecholamine-mediated multivessel epicardial spasm, microvascular coronary spasm, or possible direct catecholamine-mediated myocyte injury has been reported as possible pathophysiological mechanisms.2 MitraClip procedure is less invasive than open-heart surgery.3 However, this case demonstrates that it can nonetheless precipitate the onset of stress-induced takotsubo syndrome. Furthermore, a recent study has revealed that, in addition to emotional factors, takotsubo syndrome can also be triggered by physical factors, which was related to worse short- and long-term prognosis.4 Therefore, we should be aware of takotsubo syndrome as a potential complication of MitraClip procedure.

Consent: The author/s confirm that written consent for submission and publication of this case report including image(s) and associated text has been obtained from the patient in line with COPE guidance.

Conflict of interest: none declared.

References

  • 1. Li S, Koerner MM, El-Banayosy A, Soleimani B, Pae WE, Leuenberger UA.. Takotsubo's syndrome after mitral valve repair and rescue with extracorporeal membrane oxygenation. Ann Thorac Surg 2014;97:1777–1778. [DOI] [PubMed] [Google Scholar]
  • 2. Gianni M, Dentali F, Grandi AM, Sumner G, Hiralal R, Lonn E.. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006;27:1523–1529. [DOI] [PubMed] [Google Scholar]
  • 3. Feldman T, Foster E, Glower DD, Kar S, Rinaldi MJ, Fail PS. et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 2011;364:1395–1406. [DOI] [PubMed] [Google Scholar]
  • 4. Uribarri A, Núñez-Gil IJ, Conty DA, Vedia O, Almendro-Delia M, Duran Cambra A. et al. Short- and long-term prognosis of patients with takotsubo syndrome based on different triggers: importance of the physical nature. J Am Heart Assoc 2019;8:e013701. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from European Heart Journal: Case Reports are provided here courtesy of Oxford University Press

RESOURCES