Two Cases of "Takotsubo" Cardiomyopathy Presented with Cardiogenic Shock Immediately after Surgery for Gastrointestinal Cancer

Toshihiko Waku, Keisuke Toda, Tatsuhiro Ishii and Junichi Gangi

Department of Surgery, Saijo Municipal Shuso Hospital

Case 1: A 67-year-old man admitted for lower abdominal pain and muscular rigidity with tenderness in the lower abdomen was found in abdominal computed tomography (CT) to have intraperitoneal free air, ascites, and wall thickening in the sigmoid colon. Preoperative electrocardiography showed findings within normal limits. Under a diagnosis of sigmoid colon perforation, we partially resected the sigmoid colon and constructed a terminal colostomy. The man suddenly developed ventricular tachycardia in electrocardiography just after surgery ended and before extubation. Coronary angiography for suspected coronary ischemia showed normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Left ventricular function normalized on postoperative day 18. The man was discharged from our hospital on postoperative day 78. Case 2: An 80-year-old man admitted for pyloric stenosis had preoperative electrocardiography and echocardiography findings within normal limits. Under a diagnosis of gastric cancer, we conducted a distal gastrectomy (D2). He suddenly developed cardiogenic shock and dyspnea five hours postoperatively. Mechanical ventilation support and infusion of dopamine and dobutamine was started, but his systolic BP was still around 60 mmHg. Coronary angiography for suspected coronary ischemia showed normal arteries, but left ventriculography showed apical akinesis and basal hyperkinesis. Left ventricular function could not be normalized, and he died of cardiogenic shock two days postoperatively. The prognosis of takotsubo cardiomyopathy is generally thought to be good. We present a rare case of cardiogenic shock as a complication of takotsubo cardiomyopathy, with the patient dying two days after surgery. It is thus important for surgeons to recognize the possibility of critical complications of takotsubo cardiomyopathy occurring after gastrointestinal surgery.

Key words
takotsubo cardiomyopathy, gastrointestinal surgery, cardiogenic shock

Reprint requests
Toshihiko Waku Department of Surgery, Chyugoku Central Hospital
148-13 Kamiiwanari, Ooaza, Miyuki-cho, Fukuyama, 720-0001 JAPAN

Accepted
April 25, 2007

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