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EXPEDITED REVIEW

Transient Midventricular Ballooning Syndrome

A New Variant

R. Todd Hurst, MD^_*,_*, J. Wells Askew, MD, Christina S. Reuss, MD^_*, Richard W. Lee, MD^_*, John P. Sweeney, MD^_*, F. David Fortuin, MD^_*, Jae K. Oh, MD and A. Jamil Tajik, MD^_*

^_* Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona
Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota

Manuscript received March 8, 2006; revised manuscript received April 21, 2006, accepted April 24, 2006.

^_* Reprint requests and correspondence: Dr. R. Todd Hurst, Mayo Clinic Arizona, 13400 East Shea Boulevard/3A, Scottsdale, Arizona 85260. (Email: hurst.todd{at}mayo.edu).

We describe a new variant of transient left ventricular (LV) ballooning in North American Caucasian patients in which only the midventricle is affected. The patients described in this case series initially presented with emotional or physical stress and had similarities to transient apical ballooning syndrome; however, this variant is unique in that the transient ballooning involves the midventricle with hypercontractility of the apical and basal segments. The presentation, clinical features, and transient nature of the reported cases in this series are similar to transient LV apical ballooning and suggest a shared pathophysiologic etiology. Sparing of the apical segment with involvement of midventricle only supports etiologies not related to an epicardial coronary artery distribution. Although the pathophysiologic mechanism of the transient ventricular ballooning syndromes and other cases of catecholamine-associated transient ventricular dysfunction are not well understood, the emergence of this new variant raises further questions in the understanding of the "brain-heart" relationship.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   LV = left ventricular

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