The preoperative management of a patient with a large aneurysm of the sinus of valsalva and takotsubo cardiomyopathy

Abstract

We report a case of a 43-year-old woman, who presented with thoracic interscapular pain at a peripheral hospital. In addition, the patient reported retrosternal pain, which had occurred only hours before–after an upsetting telephone call. The CT imaging ruled out an aortic dissection but revealed a huge sinus valsalva aneurysm (SVA) while the laboratory parameters showed slightly elevated troponin T value. Echocardiography showed an akinesia of the midventricular and apical left ventricular wall, accompanied by normal basal contractility. Stenotic coronary disease and endomyocarditis could be excluded as the origin of the contractility disorders. The synopsis of the findings and patient’s medical history led to the assumption of the takotsubo cardiomyopathy triggered by stress due to the worrying telephone call and the pain originating from the symptomatic SVA. We decided to perform an elective operation of the symptomatic aneurysm after restitution of the ejection fraction—as expected in takotsubo cardiomyopathy—instead of an emergency operation.