A case of stunned myocardium with surgical stress.

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  • 外科手術に関連して発症したｓｔｕｎｎｅｄ　ｍｙｏｃａｒｄｉｕｍの１例

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Abstract

A 75-year-old man complaing of jaundice and epigastric pain was admitted to the hospital because of surgical treatment of chole-lithiasis and hepato-lithiasis. Lateral segment resection of the liver, a cholecystectomy, and a choledocholithotomy were performed. On the 8th postoperative day, we repaired his incisional wound with poor attachment. Unexpectedly, on the next day, an electrocardiogram revealed comprehensive negative T and abnormal Q without symptoms, such as chest pain. Echocardiography showed ventricular hypokinesis. With a suspicion of acute myocardial infarction, an emergency cardiac catheterization was performed. No significant coronary artery stenosis was revealed and an acetylcholine load test was also negative, although a left ventriculography showed hypokinesis at the apex cordis and inferior wall. For the purpose of clarifying the cause of left ventricular dysfunction, we practiced a myocardial scintigraphy. We saw a defect at the hypokinesis area in 123I-MIBG scintigram, while no defect area in 201T1 scintigram. Afterwards he progressed uneventfully, and this mismatch improved with a wall motion repairing during the chronic stage. We inferred that the myocardial stunning temporarily happened due to the stress associated with the repeated surgical operations. In instances in which an electrocardiogram is abnormal in the perioperative care, it would be important to differentiate between stunned myocardium and ischemic heart disease.

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