Yonsei Med J.  2017 Jan;58(1):248-251. 10.3349/ymj.2017.58.1.248.

Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement

• Sung JM
• Hong SJ
• Chung IH
• Lee HY
• Lee JH
• Kim HJ
• Byun YS
• Kim BO
• Rhee KJ

• KMID: 2374213
• DOI: http://doi.org/10.3349/ymj.2017.58.1.248

Abstract

Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.

Keyword

Takotsubo cardiomyopathy; heart rupture; complication

MeSH Terms

Acute Disease
Aged
Female
Heart Ventricles/injuries
Humans
Prognosis
Takotsubo Cardiomyopathy/*complications
Ventricular Septal Rupture/*etiology

Figure

• 

  Fig. 1 (A) Electrocardiography shows prominent ST-segment elevation in precordial leads. (B) Bedside echocardiography shows left ventricular apical ballooning with ventricular septal defect resulting from apical septal rupture (arrow) with a left-to-right shunt. (C) Coronary angiography shows no significant stenosis. LA, left atirum; LV, left ventricle; RV, right ventricle.

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  Fig. 2 (A and B) An anterolateral (black triangle) and inferior (gray triangle) wall of the LV have necrotic changes with hemorrhage. (C) The RV (white triangle) also has necrotic changes with hemorrhage. Free wall rupture (black arrow) is noted. (D) Ventricular septal wall rupture (white arrow) is observed. (E) The injured myocytes are disrupted in multiple levels (arrows) and interposed by histiocytes and lymphocytes. Groups of myocytes (squares) have increased eosinophilic staining with loss of central nuclei (hematoxylin-eosin, ×200). The infiltrating lymphocytes are CD3/CD4 positive helper T cells (CD3, ×400) (inlet). (F) Intact myocytes with myofibrils are red; injured myocytes are contrasted in blue (Masson Trichrome, ×200). LV, left ventricle; RV, right ventricle.

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