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Case Reports
. 2012 Jun 6;6(3):e70-e74.
doi: 10.1016/j.jccase.2012.05.001. eCollection 2012 Sep.

Atypical morphology and myocardial perfusion of mid-ventricular ballooning: A case report

Hirofumi Maeba  1 , Kazuya Takehana  1 , Takenori Kanazawa  1 , Takanao Ueyama  1 , Satoshi Tsujimoto  1 , Yoshinobu Suwa  1 , Yoko Miyasaka  1 , Fumio Yuasa  1 , Hiroshi Kamihata  1 , Toshiji Iwasaka  1
Affiliations
Case Reports

Atypical morphology and myocardial perfusion of mid-ventricular ballooning: A case report

Hirofumi Maeba et al. J Cardiol Cases. .

Abstract

Although some atypical types of transient left ventricular apical ballooning syndrome have been reported, only a few atypical types of transient mid-ventricular ballooning have been reported. A 70-year-old female underwent surgery for urothelial carcinoma. At day 5 after the surgery, she was admitted to our department without cardiac symptoms because of ST elevation in leads I, II, III, aVF and V1-V6 indicating acute coronary syndrome. She was diagnosed with stress induced cardiomyopathy based on an angiographically normal coronary artery, newly developed extensive wall motion abnormality (hyperbasal contraction and akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex) based on left ventriculography, and a small elevation of myocardial enzymes incongruous with the area of contraction abnormality. Myocardial scintigraphy with 99mTc-tetrofosmin showed a severely reduced myocardial perfusion in an extensive mid-ventricular area without a left ventricular base and top of apex, in accord with a wall motion abnormality different from typical apical ballooning or typical mid-ventricular ballooning previously diagnosed in our hospital. This is the first report presenting an atypical mid-ventricular ballooning based on the myocardial atypical perfusion findings.

Keywords: Atypical mid-ventricular ballooning; Myocardial perfusion; Stress induced cardiomyopathy.

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Figures

Figure 1
Figure 1
Twelve lead electrocardiogram showed ST elevations in I, II, III, aVF and VI–V6 leads.
Figure 2
Figure 2
Left ventriculography showed hyperbasal contraction, akinesis from the mid-left ventricle to the apex without hypercontraction of the small area adjacent to the apex.
Figure 3
Figure 3
Myocardial scintigraphy with 99mTc-Tf showed reduced myocardial uptake in an extensive mid-ventricular area without a left ventricular base and top of apex.
Figure 4
Figure 4
Myocardial scintigraphy with 99mTc-Tf showed typical apical ballooning previously diagnosed in our hospital.
Figure 5
Figure 5
Myocardial scintigraphy with 99mTc-Tf showed typical mid-ventricular ballooning previously diagnosed in our hospital.
See this image and copyright information in PMC

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