Andersen-Tawil syndrome (ATS) is a rare genetic disease characterized by a triad of episodic flaccid muscle weakness, ventricular arrhythmias, and physical anomalies. ATS patients have various cardiac arrhythmias that can cause sudden death. Implantation of an implantable cardioverter-defibrillator (ICD) is required when life-threatening cardiac arrhythmias do not respond to medical treatment. An 11-year-old girl underwent surgery for an ICD implantation. For general anesthesia in ATS patients, anesthesiologists should focus on the potentially difficult airway, serious cardiac arrhythmias, such as ventricular tachycardia (VT), and delayed recovery from neuromuscular blockade. We followed the difficult airway algorithm, avoided drugs that can precipitate QT prolongation and fatal cardiac arrhythmias, and tried to maintain normoxia, normocarbia, normothermia, normoglycemia, and pain control for prevention of sympathetic stimulation. We report the successful application of general anesthesia for ICD implantation in a pediatric patient with ATS and recurrent VT.

Stress-induced cardiomyopathy is characterized by reversible systolic dysfunction of the ventricles, usually involving the apical segments. It occurs more commonly in women and is frequently precipitated by emotional or physical stressors. Ever since the first report of typical stress-induced cardiomyopathy-usually known as Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome-was issued, variant forms of stress-induced cardiomyopathy have been reported. We describe a patient who presented with typical ischemic chest pain, but who was found to have an atypical form of stress-induced cardiomyopathy: midventricular ballooning syndrome involving both the left and right ventricles. Transthoracic echocardiography and computed tomography were used in this patient.
Cardiomyopathies ; Chest Pain ; Echocardiography ; Female ; Heart Ventricles ; Humans ; Takotsubo Cardiomyopathy