INTRODUCTION
Takotsubo Syndrome (TS), also known as acute left ventricle apical ballooning syndrome or stress-induced cardiomyopathy, is a rare condition, first described in Japan in the early 1990’s by Sato et al[1], characterized by hypokinesis of the left ventricle and ballooning of the apex, with hypercontractile base and non-obstructive coronary artery disease, causing a transient but potentially lethal left ventricle systolic disfunction. Despite clinical symptoms consistent with acute myocardial infarction, normal coronary arteries are usually detected upon cardiac catheterization. It is now recognized that in addition to emotional stress, also surgical procedures and administration of exogenous catecholamines play an important role as precipitant factors of the disease. Here we describe a challenging case of TS occurring after surgery for mitral valve repair complicated with systolic anterior motion of the mitral valve (SAM), severe mitral insufficiency and right ventricular disfunction.