# Successful sutureless repair of multiple left ventricular free wall ruptures due to Takotsubo cardiomyopathy: a case report

## TL;DR

A rare case of successful non-surgical repair of heart wall ruptures caused by Takotsubo cardiomyopathy is reported, offering a new treatment approach.

## Contribution

This is the first reported case of sutureless repair for multiple left ventricular ruptures caused by Takotsubo cardiomyopathy.

## Key findings

- Sutureless repair using TachoSil® patches successfully treated multiple heart wall ruptures in a patient with Takotsubo cardiomyopathy.
- The patient survived and was discharged after 71 days, demonstrating the effectiveness of the minimally invasive treatment.
- Combining TachoSil® with Surgicel Nu-Knit® and Hydrofit® achieved complete hemostasis even in the presence of hematoma.

## Abstract

Takotsubo cardiomyopathy (TCM) is a temporary and reversible systolic abnormality of the left ventricular apical area resembling a myocardial infarction. Cardiac rupture due to TCM is a rare but fatal complication. Without cardiac surgery, 94% of patients with left ventricular free wall rupture (LVFWR) due to TCM die. Furthermore, successful surgical cases are rare. We report herein the successful treatment of multiple LVFWRs due to TCM using a sutureless repair.

An 80-year-old man quarreled with his daughter and had a sudden onset of chest pain. He was transferred to our hospital in shock. Electrocardiography showed ST elevation and contrast-enhanced computed tomography revealed a bloody pericardial effusion. Emergent coronary angiography showed no significant stenosis. Cardiac arrest ensued because of cardiac tamponade. Emergent surgery was undertaken and three oozing lacerations on the lateral and inferior walls were noted. A sutureless repair was performed using TachoSil® patches. We also applied Surgicel Nu-Knit® absorbable hemostat with Hydrofit® where TachoSil® failed to completely adhere because of hematoma formation and achieved complete hemostasis. We diagnosed the ruptures due to TCM according to the Mayo criteria. The patient was discharged on postoperative day 71.

A sutureless repair using TachoSil® patches and Surgicel® with Hydrofit® is a minimally invasive and effective method for the treatment of multiple LVFWRs due to TCM.