たこつぼ型心筋障害を呈した巨大声帯ポリープの１症例

DOI 被引用文献1件 参考文献8件

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  • Takotsubo-like left ventricular dysfunction associated with impacted giant vocal cord polyp

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A woman in her sixties presented with dyspnea and was diagnosed with upper airway obstruction due to a giant vocal cord polyp. An electrocardiogram demonstrated T wave inversion in leads I, aVL, and V3-6. An echocardiogram revealed severe hypokinesis of the apical, septal, and anterior walls of the left ventricle. Since upper airway obstruction deteriorated in a short duration, an emergent tracheostomy was performed. After the operation, she developed severe hypoxemia. A chest radiograph showed pulmonary edema, mediastinal emphysema, and subcutaneous emphysema of the neck and chest wall. Emergent coronary angiography demonstrated 75% stenosis of the first diagonal branch, and left ventriculogram demonstrated Takotsubo-like left ventricular dysfunction. She was transferred to the ICU and was maintained on mechanical ventilation. On day 3, the peak CPK value was 131IU·l-1. On day 5 of admission, she was discharged from the ICU. The coronary angiography performed on day 7 showed improvement of the left ventricular function. The spasm provocation test with acetylcholine demonstrated diffuse multivessel coronary spasm. On day 22, laryngeal microsurgery was performed, and the impacted, giant vocal cord polyp was removed. This patient showed Takotsubo-like left ventricular dysfunction without significant organic coronary artery disease. Multivessel coronary spasm and significant stress due to asphyxia may contribute to the onset of this condition. We assumed that negative pressure pulmonary edema developed following upper airway obstruction because of the rapid onset and resolution of the edema.

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