Takotsubo cardiomyopathy associated with free wall rupture and ventricular septal defect: a case report.

Takotsubo cardiomyopathy is a rare cardiac presentation. It can be associated with severe complications such as hemodynamically significant ventricular septal defect and cardiac free wall rupture. In cases of mechanical complications, surgical repair is often indicated. Despite best medical and surgical efforts, patients with Takotsubo cardiomyopathy and mechanical complications carry significant mortality risk. Herein, we present an unusual presentation of Takotsubo cardiomyopathy that was associated with a mechanical complication. Although the patient underwent a successful surgical repair, she passed away from multiorgan failure during the postoperative period.

[Box: see text].

Intravascular Imaging in the Diagnosis and Management of Patients With Suspected Intracoronary Pathologies: A CJC White Paper.

Intravascular imaging has become an integral part of the diagnostic and management strategies for intracoronary pathologies. In this White Paper we summarize current evidence and its implications on the use of intravascular imaging in interventional cardiology practice. The areas addressed are planning and optimization of percutaneous coronary intervention, management of stent failure, and evaluation of ambiguous coronary lesions and myocardial infarction with nonobstructive coronary disease. The findings presented followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system in an expert consensus process that involved a diverse writing group vetted by a review group. Expert consensus was achieved around 9 statements. Use of intravascular imaging in guiding percutaneous revascularization is supported by high-quality evidence, particularly for lesions with increased risk of recurrent events or stent failure. Specific considerations for intravascular imaging guidance of intervention in left main lesions, chronic occlusion lesions, and in patients at high risk of contrast nephropathy are explored. Use of intravascular imaging to identify pathologies associated with stent failure and guide repeat intervention, resolve ambiguities in lesion assessment, and establish diagnoses in patients who present with myocardial infarction with nonobstructive coronary disease is supported by moderate- to low-quality evidence. Each topic is accompanied by clinical pointers to aid the practicing interventional cardiologist in implementation of the White Paper findings. The findings presented in this White Paper will help to guide the use of intravascular imaging toward situations in which the balance of efficacy, safety, and cost are most optimal.