We thank Dr. Hessel for the important comments and his ability to quote another report, by Ramakrishna et al. ,1of perioperative stress–induced apical ballooning (Takotsubo cardiomyopathy). The authors presented a case of a 35-yr-old woman who underwent hepatectomy and developed apical ballooning syndrome in the postoperative period.

The articles by Lentschener et al.  2and Gavish et al.  3emphasize the role of the anesthesiologist in early diagnosis and treatment of the perioperative apical ballooning syndrome.

We agree with the old adage quoted by Dr. Hessel that “we only see what we look for” as an explanation for the fact that perioperative apical ballooning was reported only recently. Furthermore, as emphasized by the famous Irish dramatist, literary critic, and social spokesman George Bernard Shaw in 1906, ideas frequently recur in the history of medicine,4with many of them being “reinvented” periodically. In fact, as we commented in our case report,3a previous description of perioperative apical ballooning was published by Mizutani and Okada5in the Japanese literature.

Supposedly, along their professional career, anesthesia practitioners might miss cases of apical ballooning or misinterpret them as myocardial ischemia. Therefore, we consider that the main message of our case report is to enhance the readers’ awareness about the potential for occurrence of Takotsubo syndrome in the perioperative period.

*Wolfson Medical Center, Holon, Israel. tezri@netvision.net.il

Ramakrishna G, Ravi BS, Chandrasekaran K: Apical ballooning syndrome in a postoperative patient with normal microvascular perfusion by myocardial contrast echocardiography. Echocardiography 2005; 22:606–10
Lentschener C, Vignauxt O, Spaulding C, Bonnichon P, Legmann P, Ozier Y: Early postoperative Tako-Tsubo -like left ventricular dysfunction: Transient left ventricular apical ballooning syndrome. Anesth Analg 2006; 103:580–2
Gavish D, Rozenman Y, Hafner R, Bartov E, Ezri T: Takotsubo cardiomyopathy after general anesthesia for eye surgery. Anesthesiology 2006; 105:621–3
Shaw GB: The doctor’s dilemma: Act I.
Mizutani K, Okada M: A case of intraoperative repeated coronary artery spasm with ST-segment depression [in Japanese]. Masui 2002; 51:1114–6