Dynamic changes in the three-dimensional mitral complex geometry in a case of takotsubo cardiomyopathy with transient systolic anterior movement of the mitral valve.

A 57-year-old female presented to us with takotsubo cardiomyopathy. Echocardiogram revealed systolic anterior movement of the mitral valve (SAM) and severe mitral regurgitation (MR) with left ventricular (LV) dysfunction. After intensive medical treatment, SAM and MR almost disappeared along with the restoration of LV wall motion abnormality. We quantitatively analyzed three-dimensional mitral complex geometry at the acute phase and the recovery phase. At the initial examination when the transient SAM was observed, annulus diameters and area were significantly smaller, compared with the recovery phase. Excessive systolic movement of the annulus along with hyperdynamic LV basal wall may contribute to the transient SAM with severe MR. Learning objective: Recent studies have suggested systolic anterior movement of the mitral valve (SAM) causes acute mitral regurgitation in patients with takotsubo cardiomyopathy. However, the mechanism of transient SAM in Takotsubo cardiomyopathy remains unclear. This is the first report that assessed the unique geometric mechanisms of transient SAM in Takotsubo cardiomyopathy.