J Korean Med Sci.  2008 Oct;23(5):898-902. 10.3346/jkms.2008.23.5.898.

Catecholamines May Play an Important Role in the Pathogenesis of Transient Mid- and Basal Ventricular Ballooning Syndrome

• Kim EM
• Park JH
• Park YS
• Lee JH
• Choi SW
• Jeong JO
• Seong IW

• KMID: 1783080
• DOI: http://doi.org/10.3346/jkms.2008.23.5.898

Abstract

The exact pathogenesis of transient mid- and basal ventricular ballooning, a new variant of transient left ventricular (LV) ballooning, remains unknown. We report two cases of transient mid- and basal ventricular ballooning associated with catecholamines. These cases suggest that catecholamine-mediated myocardial dysfunction might be a potential mechanism of this syndrome.

Keyword

Ventricular Dysfunction, Left; Catecholamines; Pheochromocytoma

MeSH Terms

Adult
Cardiomyopathies/pathology
Catecholamines/*metabolism
Coronary Vessels/pathology
Heart Catheterization
Heart Ventricles/pathology
Humans
Male
Middle Aged
Myocardial Contraction
Myocardium/pathology
Syndrome
Tomography, X-Ray Computed/methods
Ventricular Dysfunction, Left/diagnosis/*physiopathology

Figure

• 

  Fig. 1 An apical four-chamber view of the left ventricle in the emergency department is shown at end-diastole (A) and end-systole (B). At end-systole, mid- and basal ventricular ballooning was noted. The follow-up echocardiographic study was performed after three days of treatment. The left ventricular dimension was decreased and ballooning had disappeared (C at end-diastole and D at end-systole).

• 

  Fig. 2 The coronary angiogram showed normal left (A) and right coronary arteries (B). The left ventriculogram in the right anterior oblique view showed at end-diastole (C) and end-systole (D). At end-systole, mid- and basal ventricular ballooning was noted. However, LV apical motion was normal.

• 

  Fig. 3 (A) Abdominal computerized tomography showed an approximately 7.8×8.3×10.0 cm sized large septated cystic mass with irregular wall enhancement of the right adrenal gland (arrow). (B) Large and pink cells are arranged in nests with capillaries between them in the high power field image, which is compatible with pheochromocytoma.

• 

  Fig. 4 An apical four-chamber view of the left ventricle after operation is shown at end-diastole (A) and end-systole (B). At end-systole, the mid-and basal ventricular ballooning was noted with sparing of the LV apex. A follow-up echocardiographic study was performed after two days. The left ventricular dimension had decreased and ballooning was no longer present (C at end-diastole and D at end-systole).

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