Report of takotsubo cardiomyopathy occurring during cardiopulmonary bypass

On weaning from cardiopulmonary bypass, a 59-year-old Japanese woman with mitral valve plasty suddenly showed a greatly increased heart rate, and an electrocardiogram revealed elevated ST-segments. There was also abnormal wall motion in the inferior region and apical ballooning of the left ventricle. We diagnosed the condition as takotsubo cardiomyopathy (acute left ventricle apical ballooning syndrome), possibly caused by catecholamine release and regional stress-induced ischemia. We believe this to be the first case report of takotsubo cardiomyopathy observed during heart surgery. We hypothesize that the condition was mediated by regional myocardial stunning and that it could be prevented by administration of angiotensin converting enzyme inhibitors before surgery and by the use of superior biocompatible cardiopulmonary bypass components. Once takotsubo cardiomyopathy occurs, we recommend mechanical circulatory assistance during weaning from the bypass.