https://doi.org/10.1007/s00392-025-02625-4
1Asklepios Klinik St. Georg Kardiologie & internistische Intensivmedizin Hamburg, Deutschland; 2Asklepios Klinik Wandsbek Innere Medizin Kardiologie & Pneumologie Hamburg, Deutschland
Background: Tako-Tsubo cardiomyopathy (TC) is a rare condition characterized by reversible left ventricular dysfunction and ballooning of the left ventricular apex, mimicking acute myocardial infarction. Generally, TC was considered a benign disease, however more recently rates of cardiogenic shock and death are reported comparable to acute coronary syndrome patients. Ventricular septal perforation is an infrequent life-threatening complication associated with high mortality, typically seen in ST elevation myocardial infarction.
Case presentation: We report a case of a 72-year-old woman suffering from ventricular septal defect (VSD) induced by TC. Our patient presented with clinical signs of nausea and shortness of breath. The electrocardiogram demonstrated anterior ST-segment elevation, laboratory testing was noticeable for elevated troponin I (hs) of 316 ng/l. Echocardiography revealed severe left ventricular dysfunction with apical ballooning and ventricular septal defect. Subsequent coronary angiography revealed no abnormalities. Due to severe heart failure with NTproBNP maximum of 29608ng/l, evidence of pleural effusion and necessary non-invasive ventilation, heart failure therapy was initiated. The patient underwent percutaneous VSD repair via Figulla Flex II ASD by Occlutech®, resulting in partial VSD repair (Figure). Cardiovascular magnetic resonance imaging confirmed a persistent VSD with a flow ratio Qp/Qs of 2:1. Further surgical repair could not be performed owing to severe comorbidity. Five weeks after hospital admission our patient could be discharged in stable clinical condition.
Conclusions: Ventricular septal perforation can occur in TC. Early recognition and management of this complication is of major importance to avoid or reduce morbidity and mortality.
Figure: Electrocardiogram demonstrated anterior ST-segment elevation (A), transthoracic echocardiography (apical 4-chamber view) showed ventricular septal defect closure by a percutaneous septal Occluder Device (Figulla Flex II Occlutech®) (B), coronary angiography revealed no abnormalities of right (C) and left (D) coronary artery.