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Nobuyuki Kagiyama, Hiroyuki Okura, Teruyoshi Kume, Akihiro Hayashida, Kiyoshi Yoshida, Isolated right ventricular takotsubo cardiomyopathy, European Heart Journal - Cardiovascular Imaging, Volume 16, Issue 3, March 2015, Page 285, https://doi.org/10.1093/ehjci/jeu207
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An 89-year-old woman experienced sudden dyspnoea and chest pain 3 days after total hip replacement surgery. The patient had a slightly elevated troponin T level. Echocardiography showed right ventricular (RV) enlargement and akinesis of the RV-free wall, with preserved wall motion of the RV apex (Panel A; Supplementary data online, Video S1). Left ventricular wall motion was preserved. Cardiac magnetic resonance imaging also showed the wall motion abnormality to be localized in the free wall of the RV (Panel B; Supplementary data online, Video S2). Pulmonary embolism and coronary artery disease as a cause of the RV wall motion abnormality were excluded by a contrast-enhanced multi-detector computed tomography scan (Panel C). She was diagnosed as an isolated RV takotsubo cardiomyopathy (TC) and was conservatively managed. On postoperative day 11, follow-up echocardiography showed improvement in wall motion of the RV (Panel D; Supplementary data online, Video S3).
Previous studies have reported some variant forms of wall motion abnormality in TC, such as mid-ventricular and biventricular types. The biventricular type was first reported in 2000 and had been recognized as a very rare form of TC until in 2006, systematically reported as a possible variant in about one-third of patients with TC. Left ventriculography, a classical gold standard in diagnosis of TC, is unable to observe the wall motion of the RV. Similarly, echocardiography without careful observation of the RV can overlook RV abnormality. Thus, isolated RV TC, or TC localized in the free wall of the RV may be a new, emerging variant of TC.
