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Liao S, Jin P, Miao R, Huang X. Multimodality imaging for the diagnosis of left ventricular apical hypoplasia: A case presentation and review of the literatures. Echocardiography 2024; 41:e15793. [PMID: 38506265 DOI: 10.1111/echo.15793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
Left ventricular apical hypoplasia is a rare malformation recently described congenital abnormality characterized by: (1) truncation of the left ventricle, with the septum projecting toward the right ventricle; (2) abnormal papillary muscle originating from the flattened left ventricular apex; (3) a narrow right ventricle encompassing the periapical area of the left ventricle; (4) fatty infiltration of the apex of the left ventricle. We reported a case of LVAH and reviewed the patient's clinical presentation. And its morphologic characteristics were revealed by multimodality imaging, including echocardiography and cardiac magnetic resonance imaging. Additionally, we reviewed 41 cases from 32 reports to summarize the pathogenesis and analyzed the imaging manifestations of LVAH in this study, aiming to provide new ideas for the diagnosis and clinical management of LVAH patients.
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Affiliation(s)
- Shusheng Liao
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Peifeng Jin
- Department of Cardiovascular Surgery, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rongrong Miao
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xinshi Huang
- Department of Ultrasound, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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2
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Aliaga F, Alegría J, Díaz JC. "NASCI case of the month: left ventricular apical hypoplasia". THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:295-297. [PMID: 38038812 DOI: 10.1007/s10554-023-03016-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 12/02/2023]
Abstract
Left ventricular apical hypoplasia is a rare congenital condition. It can cause nonspecific symptoms and can be accompanied by cardiac conduction system alterations such as bundle branch block, atrial flutter (AF) or atrial fibrillation. The diagnosis mostly is made by imaging.
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Affiliation(s)
- Francisca Aliaga
- Radiology Resident at Clínica Alemana de Santiago, Universidad del Desarrollo Faculty of Medicine, Santiago, Chile
| | - Julia Alegría
- Cardiothoracic Imaging Radiologist at Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago, Chile.
| | - Juan Carlos Díaz
- Cardiothoracic Imaging Radiologist at Clínica Alemana de Santiago, Avenida Vitacura 5951, Vitacura, Santiago, Chile
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Şahin S, Özbülbül NI. Cardiac magnetic resonance imaging findings of isolated left ventricular apical hypoplasia. J Cardiol Cases 2023; 28:221-223. [PMID: 38024111 PMCID: PMC10658309 DOI: 10.1016/j.jccase.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/01/2023] [Accepted: 07/18/2023] [Indexed: 12/01/2023] Open
Abstract
Isolated left ventricular apical hypoplasia (ILVAH) is an uncommon and likely congenital cardiac abnormality that has been described as relatively new. ILVAH is characterized by a truncated, globular-shaped left ventricle (LV) with bulging of the interventricular septum toward the right ventricle (RV), wrapping of an elongated and lengthened RV around the absent LV apex, thinning and fat replacement of apical myocardium of the LV, and abnormalities in the papillary muscle arrangement of the LV. In this report, we present the cardiac magnetic resonance imaging findings of a 22-year-old female patient with non-specific cardiac complaints that were compatible with ILVAH. Recognition of this rare cardiomyopathy is important for clinicians and radiologists in order to follow up on patients with ILVAH, as it may lead to severe complications, and to distinguish it from other cardiomyopathies. Learning objective Isolated left ventricular apical hypoplasia (ILVAH) is a rare congenital cardiomyopathy that has some serious complications, such as left-sided heart failure, severe pulmonary hypertension, and fatal arrhythmias. By recognizing and identifying the cardiac magnetic resonance imaging findings of ILVAH, clinicians and radiologists can take appropriate measures to manage and treat patients with this condition, potentially improving outcomes and reducing the risk of complications.
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Affiliation(s)
- Sercan Şahin
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
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Bassareo PP, Duignan S, James A, Dunne E, McMahon CJ, Walsh KP. Isolated left ventricular apical hypoplasia: Systematic review and analysis of the 37 cases reported so far. World J Clin Cases 2023; 11:5494-5503. [PMID: 37637686 PMCID: PMC10450389 DOI: 10.12998/wjcc.v11.i23.5494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Isolated left ventricular apical hypoplasia (ILVAH), also known as truncated left ventricle (LV), is a very unusual cardiomyopathy. It is characterised by a truncated, spherical, and non-apex forming LV. The true apex is occupied by the right ventricle. Due to the rarity of the disease, just a few case reports and limited case series have been published in the field. AIM To analysing the so far 37 reported ILVAH cases worldwide. METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13, 2022. RESULTS The majority of cases reported occurred in males (52.7%). Mean age at diagnosis was 26.1 ± 19.6 years. More than a third of the patients were asymptomatic (35.1%). The most usual clinical presentation was breathlessness (40.5%). The most commonly detected electrocardiogram changes were T wave abnormalities (29.7%) and right axis deviation with poor R wave progression (24.3%). Atrial fibrillation/flutter was detected in 24.3%. Echocardiography was performed in 97.3% of cases and cardiac MRI in 91.9% of cases. Ejection fraction was reduced in more than a half of patients (56.7%). An associated congenital heart disease was found in 16.2%. Heart failure therapy was administered in 35.1% of patients. The outcome was favorable in the vast majority of patients, with just one death. CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course, ranging from benign until the elderly to sudden death during adolescence.
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Affiliation(s)
- Pier Paolo Bassareo
- University College of Dublin, School of Medicine and Department of Cardiology at Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland
| | - Sophie Duignan
- Department of Cardiology, Children's Health Crumlin, Dublin D12 N512, Ireland
| | - Adam James
- Department of Cardiology, Children's Health Crumlin, Dublin D12 N512, Ireland
| | - Esme Dunne
- Department of Cardiology, Children's Health Crumlin, Dublin D12 N512, Ireland
| | - Colin J McMahon
- University College of Dublin, School of Medicine and Department of Cardiology, Children's Health Ireland, Dublin D12 N512, Ireland
| | - Kevin P Walsh
- University College of Dublin, School of Medicine and Department of Cardiology at Mater Misericordiae University Hospital, Dublin D07 R2WY, Ireland
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Román R, Anchante H, Menacho K, Medina F. Isolated left ventricular apical hypoplasia: case report. Eur Heart J Case Rep 2023; 7:ytad046. [PMID: 36845834 PMCID: PMC9945848 DOI: 10.1093/ehjcr/ytad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/08/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
Background Isolated left ventricular apical hypoplasia (ILVAH) is a rare, probably congenital, cardiac condition recently reported in the last two decades. Although most cases are asymptomatic or mildly symptomatic, some severe and fatal cases have been reported, leading to more efforts for appropriate diagnosis and treatment. We describe the first, and severe, case of this pathology in Peru and Latin America. Case summary A 24-year-old male with a history of long-standing alcohol and illicit drug use presented with symptoms of heart failure (HF) and atrial fibrillation (AF). Transthoracic echocardiography showed biventricular dysfunction along with spherical left ventricle, abnormal papillary muscles' origin from the left ventricular apex, and an elongated right ventricle wrapping around the deficient left ventricular apex. Cardiac magnetic resonance confirmed these findings and revealed subepicardial fatty replacement at the left ventricular apex. The diagnosis of ILVAH was made. He was discharged from hospital with carvedilol, enalapril, digoxin, and warfarin. Eighteen months later he remains mildly symptomatic at New York Heart Association functional class II without worsening HF nor thrombo-embolism. Discussion This case highlights the usefulness of multimodality non-invasive cardiovascular imaging for accurate diagnosis of ILVAH as well as the importance of close follow-up and treatment of established complications (HF and AF).
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Affiliation(s)
- Ricardo Román
- Corresponding author. Tel: +51 968 517 989, Fax: +51 511 482 1410,
| | - Henry Anchante
- Division of Cardiology, Cayetano Heredia Hospital, San Martin de Porres, Lima 15102, Perú
| | - Katia Menacho
- Barts Heart Centre, St Bartholomew’s Hospital, W Smithfield, London EC1A 7BE, UK
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Dattani A, Prasad R. Isolated Left Ventricular Apical Hypoplasia. Card Fail Rev 2022; 7:e21. [PMID: 35024171 PMCID: PMC8728883 DOI: 10.15420/cfr.2021.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester Leicester, UK
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Sato R, Ishigaki M, Ito H, Mitsushita N, Sakamoto K, Iwamoto Y, Ishido H, Taketazu M, Senzaki H, Masutani S. Progression of left ventricular apical hypoplasia-like restrictive cardiomyopathy with severe pulmonary hypertension: Follow-up from fetal stage. J Cardiol Cases 2021; 24:161-164. [DOI: 10.1016/j.jccase.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/17/2022] Open
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Marinelli A, Costa A, Dugo C, Cecchetto A, Lanzoni L, Molon G. A unique case of left ventricle apical hypoplasia presenting with a type 1 Brugada ECG pattern and NEXN mutation. Are they related? HeartRhythm Case Rep 2021; 7:273-277. [PMID: 34026514 PMCID: PMC8134760 DOI: 10.1016/j.hrcr.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alessio Marinelli
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Alessandro Costa
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Clementina Dugo
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | | | - Laura Lanzoni
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
| | - Giulio Molon
- IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Italy
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Liao HQ, Peng ZF, Zhang M, Tan Y, Ouyang MZ, Zhou D, Tang K, Tang SX, Shang QL. Isolated ventricular apical hypoplasia: A report of four cases and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:78-82. [PMID: 32530510 DOI: 10.1002/jcu.22858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/11/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
Isolated ventricular apical hypoplasia (IVAH) is a rare congenital cardiac anomaly, with clinical manifestations depending on the age of the patient, ranging from no symptoms in children to congestive heart failure or even malignant tachycardia in adults. Herein, we describe the clinical and anatomical findings in four cases with hypoplasia of the right or left ventricular apex, and we discuss the possible mechanisms and differential diagnosis of this malformation. Echocardiography is a rapidly accessible, low cost, noninvasive technique for the detection and evaluation of IVAH.
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Affiliation(s)
- Hai-Qin Liao
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ze-Fang Peng
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ming Zhang
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yi Tan
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Min-Zhi Ouyang
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dan Zhou
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Kui Tang
- Department of Ultrasound, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shi-Xiong Tang
- Department of Radiology, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Quan-Liang Shang
- Department of Radiology, The 2nd Xiangya Hospital of Central South University, Changsha, Hunan, China
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Choh NA, Amreen S, Mir AB, Malik AH, Hameed M, Shaheen F, Gojwari TA. Isolated left ventricular hypoplasia - A singularity. Ann Pediatr Cardiol 2020; 13:337-339. [PMID: 33311923 PMCID: PMC7727894 DOI: 10.4103/apc.apc_88_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/20/2019] [Accepted: 07/08/2020] [Indexed: 11/04/2022] Open
Abstract
Isolated left ventricular hypoplasia is an entity with uncertain natural history and etiology. The presentation could vary from being asymptomatic to sudden death. This form of cardiomyopathy has been reported in infants as well as in adults. This case report aims to alert physicians to this diagnosis and the undeniable advantage of cardiac magnetic resonance.
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Affiliation(s)
- Naseer A Choh
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
| | - Saika Amreen
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
| | - Amber Bashir Mir
- Department of Pediatric Cardiology, GB Pant Children Hospital, Srinagar, Jammu and Kashmir, India
| | - Aadil Hussain Malik
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
| | - Mudasir Hameed
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
| | - Feroze Shaheen
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
| | - Tariq A Gojwari
- Department of Radiodiagnosis, SKIMS Soura, Srinagar, Jammu and Kashmir, India
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Skidan VI, Kuznetsova T, Pavlyukova EN, Nartsissova GP. Isolated left ventricular apical hypoplasia with myocardial non-compaction: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 4:1-6. [PMID: 32128492 PMCID: PMC7047060 DOI: 10.1093/ehjcr/ytz215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/13/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
Background Isolated left ventricular apical hypoplasia (ILVAH) is a rare congenital cardiac abnormality, which might result in severe symptomatic heart failure (HF) with pulmonary hypertension, atrial fibrillation (AF), or malignant ventricular tachycardia in adults. Case summary A 32-years-old man presented with exertional dyspnoea New York Heart Association Class II and persistent AF. Echocardiography and cardiac magnetic resonance showed the presence of (i) spherical remodelling of the left ventricle (LV) with impaired contractile function (three-dimensional ejection fraction, EF 32%); (ii) substitution of apical myocardium by fatty tissue; (iii) abnormal origin of a papillary muscle network; and (iv) an elongated right ventricle, compatible with ILVAH. In addition, non-compacted endomyocardial layer of the LV was observed. Because of a high risk of sudden cardiac death in symptomatic HF patients with reduced EF, an implantable cardioverter-defibrillator was placed which followed by pulmonary vein isolation. After the procedures and restoration of sinus rhythm, the patient demonstrated improvement in HF symptoms and exercise tolerance. This was accompanied by an enhancement of left and right ventricular systolic function by echocardiography. At 6-month, 1, and 2-year follow-up the clinical conditions of the patient and echocardiographic findings remained stable. Discussion A rare combination of ILVAH and left ventricular myocardium non-compaction was observed in this young adult who presented with symptomatic HF and persistent AF. The use of consecutive invasive cardiac procedures leads to restoration of sinus rhythm, the improvement of myocardial contractility and clinical manifestation of HF.
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Affiliation(s)
- Viktoria I Skidan
- Federal Center of Cardiovascular Surgery, 2v Krasnodarskaya str., Khabarovsk 680000, Russian Federation
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Galina P Nartsissova
- National Medical Research Center named after E.N. Meshalkin, Novosibirsk, Russian Federation
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Schapiro AH, Rattan MS, Moore RA, Dillman JR. Case 262: Isolated Left Ventricular Apical Hypoplasia. Radiology 2019; 290:569-573. [PMID: 30673498 DOI: 10.1148/radiol.2019161902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 17-year-old white male adolescent was re-evaluated for a withheld cardiac condition initially detected during prenatal imaging at an outside institution. He had previously experienced intermittent episodes of shortness of breath, chest pain, and palpitations with exertion, but more recently he had been asymptomatic. He had no other comorbidities and no family history of congenital heart disease, cardiomyopathy, arrhythmia, or sudden cardiac death. At physical examination, the patient had a grade II/IV rumbling systolic murmur best heard at the left upper sternal border. Otherwise, cardiovascular and other physical examination findings were normal. An electrocardiogram showed sinus bradycardia and nonspecific T wave changes. A graded exercise stress test was normal. Cardiac MRI was performed without and with gadolinium-based contrast material. Multiple echocardiograms obtained since birth, cardiac MR images obtained 2 and 4 years earlier, and nongated CT images obtained with iodinated contrast material to evaluate trauma 8 years prior showed findings similar to those of the current examination. Prior chest radiographs (not shown) were normal, and angiography performed when the patient was 4 years old revealed normal coronary arteries.
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Affiliation(s)
- Andrew H Schapiro
- From the Department of Radiology and Medical Imaging (A.H.S., M.S.R., J.R.D.) and Division of Cardiology (R.A.M.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Mantosh S Rattan
- From the Department of Radiology and Medical Imaging (A.H.S., M.S.R., J.R.D.) and Division of Cardiology (R.A.M.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Ryan A Moore
- From the Department of Radiology and Medical Imaging (A.H.S., M.S.R., J.R.D.) and Division of Cardiology (R.A.M.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Jonathan R Dillman
- From the Department of Radiology and Medical Imaging (A.H.S., M.S.R., J.R.D.) and Division of Cardiology (R.A.M.), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229
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Zhou D, Liao HQ, Ouyang MZ, Shang QL, Zhang M. Isolated right ventricular apical hypoplasia characterized by computed tomography and echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:82-84. [PMID: 28370066 DOI: 10.1002/jcu.22479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 02/14/2017] [Accepted: 02/22/2017] [Indexed: 06/07/2023]
Abstract
Isolated right ventricular apical hypoplasia is an unusual congenital heart disease that has been mentioned in only one report to our knowledge. We describe the case of a 62-year-old male patient suffering from recurrent abdominal distention, nausea, and lower extremity edema. The right ventricular morphologic abnormalities as shown by echocardiography and CT were comparable to those of left ventricular apical hypoplasia, suggesting right ventricular apical hypoplasia. However, this speculative diagnosis remains to be confirmed by additional cases. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:82-84, 2018.
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Affiliation(s)
- Dan Zhou
- Department of Ultrasound Diagnosis, the Second Xiangya Hospital, Central South University, Changsha, Hunan410011, China
| | - Hai-Qin Liao
- Department of Ultrasound Diagnosis, the Second Xiangya Hospital, Central South University, Changsha, Hunan410011, China
| | - Min-Zhi Ouyang
- Department of Ultrasound Diagnosis, the Second Xiangya Hospital, Central South University, Changsha, Hunan410011, China
| | - Quan-Liang Shang
- Department of Radiology, the Second Xiangya Hospital, Central South University, Changsha, Hunan410011, China
| | - Ming Zhang
- Department of Ultrasound Diagnosis, the Second Xiangya Hospital, Central South University, Changsha, Hunan410011, China
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Mirdamadi A, Ashrafi S. Isolated Left Ventricular Apical Hypoplasia: Reporting a Case With Mild Manifestations and Different Echocardiography Features. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e26065. [PMID: 27800175 PMCID: PMC5076384 DOI: 10.5812/ircmj.26065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 07/07/2015] [Accepted: 08/18/2015] [Indexed: 11/29/2022]
Abstract
Introduction Isolated left ventricular apical hypoplasia is an unusual type of cardiomyopathy that presents with different clinical manifestations according to the age of the disease, ranging from no symptoms in children to congestive heart failure, pulmonary edema, or even malignant tachycardia in adults. To our knowledge, only a few cases of isolated left ventricular apical hypoplasia have been reported in Asian adults. Case Presentation Herein, we described an adult case of isolated left ventricular apical hypoplasia referred to our heart center in Isfahan, Iran in 2015 with a complaint of mild dyspnea with the absence of obvious fatty tissue in the heart’s apex and an absence of any shunt, which are common findings in patients with this phenomenon. Conclusions Patients faced with isolated left ventricular apical hypoplasia should be monitored by echocardiography because of this disease’s possible progressive trend to life-threatening consequences.
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Affiliation(s)
- Ahmad Mirdamadi
- Islamic Azad university, Najafabad Branch, Isfahan, IR Iran
- Corresponding Author: Ahmad Mirdamadi, Islamic Azad university, Najafabad Branch, Isfahan, IR Iran, E-mail:
| | - Samira Ashrafi
- Isfahan University of Medical Sciences, Isfahan, IR Iran
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15
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Ding WY, Meah M, Rao A, Fairbairn T, Hasleton J. Isolated Left Ventricular Hypoplasia in a Postpartum Patient. Can J Cardiol 2016; 32:829.e15-7. [DOI: 10.1016/j.cjca.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 08/11/2015] [Accepted: 08/16/2015] [Indexed: 10/23/2022] Open
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Zhao Y, Zhang J, Zhang J. Isolated Left Ventricular Apical Hypoplasia with Right Ventricular Outflow Tract Obstruction: A Rare Combination. Ann Noninvasive Electrocardiol 2016; 20:502-5. [PMID: 26417869 DOI: 10.1111/anec.12234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Isolated left ventricular (LV) apical hypoplasia is a unusual and recently recognized congenital cardiac anomaly. A 19-year-old man was found to have an abnormal ECG and cardiac murmur identified during a routine health check since joining work. His ECG revealed normal sinus rhythm, right-axis deviation, poor R wave progression, and T wave abnormalities. On physical examination, a 2/6~3/6 systolic murmur was heard at the second intercostal space along the left sternal border. Subsequent echocardiography and cardiac magnetic resonance imaging confirmed the LV apical hypoplasia. Of note, we first found that LV apical hypoplasia was accompanied by RV outflow tract obstruction due to exaggerated rightward bulging of the basal-anterior septum during systole. A close follow-up was performed for the development of heart failure, pulmonary hypertension, and potentially tachyarrhythmia.
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Affiliation(s)
- Yonghui Zhao
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jiaying Zhang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Jing Zhang
- Department of Cardiology, Henan Provincial People's Hospital, Zhengzhou, Henan, China
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Isolated hypoplasia of the left ventricular apex. Int J Cardiovasc Imaging 2016; 32:281-282. [DOI: 10.1007/s10554-015-0765-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
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Hong SH, Kim YM, Lee HJ. Three-Dimensional Endo-Cardiovascular Volume-Rendered Cine Computed Tomography of Isolated Left Ventricular Apical Hypoplasia: A Case Report and Literature Review. Korean J Radiol 2016; 17:79-82. [PMID: 26798219 PMCID: PMC4720816 DOI: 10.3348/kjr.2016.17.1.79] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/04/2015] [Indexed: 11/23/2022] Open
Abstract
We report multidetector computed tomography (MDCT) and cardiac magnetic resonance (CMR) findings of a 34-year-old female with isolated left ventricular apical hypoplasia. The MDCT and CMR scans displayed a spherical left ventricle (LV) with extensive fatty infiltration within the myocardium at the apex, interventricular septum and inferior wall, anteroapical origin of the papillary muscle, right ventricle wrapping around the deficient LV apex, and impaired systolic function. MDCT visualized morphologic and also functional findings of this unique cardiomyopathy.
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Affiliation(s)
- Sun Hwa Hong
- Department of Radiology, Sejong General Hospital, Bucheon 14754, Korea
| | - Yang Min Kim
- Department of Radiology, Sejong General Hospital, Bucheon 14754, Korea
| | - Hyun Jong Lee
- Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Bucheon 14754, Korea
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Alizadeh Sani Z, Vojdanparast M, Rezaeian N, Seifi A, Omidvar Tehrani S, Nezafati P. Left ventricular apical hypoplasia: Case report on cardiomyopathy and a history of sudden cardiac death. ARYA ATHEROSCLEROSIS 2016; 12:50-4. [PMID: 27114737 PMCID: PMC4834181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND Isolated left ventricular apical hypoplasia with several different unrecognized dimensions is a newly discovered congenital anomaly of the heart. CASE REPORT In this report, we describe a case of cardiomyopathy of this type occurring in a 13-year-old male with a history of mental retardation and sudden cardiac death (SCD) of second-degree relatives. The patient was referred for an evaluation of cardiac status. An echocardiography analysis demonstrated a spherical left ventricle (LV) appearance with mild mitral regurgitation. Cardiac magnetic resonance imaging (MRI) confirmed a spherical and truncated LV appearance. The right ventricle was found to have elongated and wrapped around the LV, and diverticulum was also seen in the cardiac MRI. CONCLUSION To the best of our knowledge, this is to present the first case of LV apical hypoplasia combined with LV diverticulum and a family history of SCD. As more cases featuring this cardiomyopathy type are recognized, it will be easier to elucidate the natural history and management of such cardiac anomalies.
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Affiliation(s)
- Zahra Alizadeh Sani
- Assistant Professor, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Vojdanparast
- Cardiologist, Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Rezaeian
- Assistant Professor, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azin Seifi
- Student of Medicine, Department of Medical Sciences, School of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
| | - Sahar Omidvar Tehrani
- Student of Medicine, Cardiac Surgery Research Committee AND Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Pouya Nezafati
- Student of Medicine, Cardiac Surgery Research Committee AND Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran,Correspondence to: Pouya Nezafati,
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20
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Raza A, Waleed M, Balerdi M, Bragadeesh T, Clark AL. Idiopathic left ventricular apical hypoplasia. BMJ Case Rep 2014; 2014:bcr-2013-202532. [PMID: 24585345 DOI: 10.1136/bcr-2013-202532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 46-year-old man was found to have an abnormal ECG taken during a routine health and blood pressure check. His only symptom was non-specific central chest discomfort, unrelated to exertion. His ECG showed sinus rhythm, a normal axis and poor R wave progression across the chest leads and lateral T wave flattening. An echocardiogram showed a dilated left ventricle with a thin and hypokinetic septum bulging to the right. The apex was 'not well seen' but also appeared thin and hypokinetic. The right heart and valves were normal. The patient was further investigated for left ventricular hypoplasia.
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Affiliation(s)
- Ali Raza
- Department of Cardiology, Castle Hill Hospital, East Yorkshire, UK
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Baroni M, Pedrotti P, Nava S, Giannattasio C, Roghi A. Cardiac Magnetic Resonance Imaging of Left Ventricular Apical Hypoplasia in Two Complex Congenital Clinical Syndromes. Circ J 2014; 78:1507-9. [DOI: 10.1253/circj.cj-13-1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Matteo Baroni
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Patrizia Pedrotti
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Stefano Nava
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Cristina Giannattasio
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Alberto Roghi
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
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Moon JI, Jeong YJ, Lee G, Choi JH, Lee JW. Isolated left ventricular apical hypoplasia with infundibular pulmonary and aortic stenosis: a rare combination. Korean J Radiol 2013; 14:874-7. [PMID: 24265561 PMCID: PMC3835633 DOI: 10.3348/kjr.2013.14.6.874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/22/2013] [Indexed: 11/15/2022] Open
Abstract
Isolated left ventricular (LV) apical hypoplasia is a rare congenital cardiac anomaly which is not accompanied by other cardiac abnormalities, with the exception of two cases. We report a case of a 33-year-old male patient with isolated LV apical hypoplasia combined with infundibular pulmonary stenosis and aortic stenosis. We review a literature focusing on the characteristic magnetic resonance features and combined cardiac abnormalities.
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Affiliation(s)
- Jin Il Moon
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
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23
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Ong CC, Hia CPP, Lim TCW, Teo LLS. Isolated left-ventricular apical hypoplasia presenting as a left-ventricular mass on echocardiography. Pediatr Cardiol 2012; 33:1456-7. [PMID: 22576770 DOI: 10.1007/s00246-012-0349-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 04/25/2012] [Indexed: 11/29/2022]
Abstract
Left-ventricular apical hypoplasia is a rare entity. Although it has typical imaging features on cardiovascular magnetic resonance, recognizing this condition on echocardiography can be challenging. This report describes an asymptomatic pediatric patient who initially presented with a left-ventricular mass on echocardiography.
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Affiliation(s)
- Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, 1E Kent Ridge Road, Tower block, Level 12, Singapore, 119228, Singapore
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24
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Tumabiene KD, Magpali AE, Chiong L, Jara RD, Abarquez RF, Abelardo NS. A plump and fatty heart: isolated left ventricular apical hypoplasia. Echocardiography 2012; 29:E193-6. [PMID: 22694050 DOI: 10.1111/j.1540-8175.2012.01741.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Isolated left ventricular apical hypoplasia is a newly recognized type of cardiomyopathy, with only a few cases reported since it was first described in 2004. We report this case of a 21-year-old Filipino female presenting with unstable supraventricular arrhythmia and heart failure, with characteristic features of isolated left ventricular apical hypoplasia on echocardiography and cardiac magnetic resonance imaging. To our knowledge, this is the first reported adult case in Asia.
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Affiliation(s)
- Kristine D Tumabiene
- Section of Cardiology, University of the Philippines-Philippine General Hospital (UP-PGH), Manila, Philippines.
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25
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Isolated left ventricular apical hypoplasia evaluated by cardiovascular magnetic resonance and gadolinium enhancement techniques. J Am Coll Cardiol 2011; 58:2355. [PMID: 22093515 DOI: 10.1016/j.jacc.2011.02.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 02/15/2011] [Indexed: 11/20/2022]
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Abstract
Isolated left ventricular (LV) apical hypoplasia is a recently described congenital abnormality characterized by: (1) a truncated and spherical LV configuration with rightward bulging of the interventricular septum, (2) deficiency of the myocardium within the LV apex with adipose tissue infiltrating the apex, (3) origin of the papillary muscle in the flattened anterior apex, and (4) elongation of the right ventricle wrapping around the deficient LV apex. In this report, we demonstrate these characteristic features with cardiac magnetic resonance imaging and summarize the existing information on isolated LV apical hypoplasia.
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Affiliation(s)
- Thomas E Vanhecke
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
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Haffajee JA, Finley JJ, Brooks EL, Kuvin JT, Patel AR. Echocardiographic characterization of left ventricular apical hypoplasia accompanied by a patent ductus arteriosus. Eur Heart J Cardiovasc Imaging 2010; 12:E17. [PMID: 21131656 DOI: 10.1093/ejechocard/jeq170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Left ventricular (LV) apical hypoplasia is an unusual, recently identified cardiomyopathy, whose clinical course is uncertain. In this report, we describe a case of this cardiomyopathy occurring in an asymptomatic 50-year-old male with a remote history of a surgically corrected patent ductus arteriosus (PDA), primarily using transthoracic echocardiography (TTE) to illustrate the imaging characteristics. This patient had been referred to our institution for an abnormal electrocardiogram, and TTE subsequently (Figure 1) revealed a dilated left ventricle with moderately to severely reduced function; LV ejection fraction was 30% by two- and three-dimensional quantification. The left ventricle had a spherical appearance with a thin-walled, truncated, and akinetic distal LV. The right ventricle appeared elongated and was noted to wrap around the distal left ventricle, but right ventricular systolic function was normal. There were no significant valvular abnormalities, and no evidence of residual PDA flow. Subsequent cardiac magnetic resonance (CMR) imaging confirmed these findings (Figure 1). The TTE and CMR findings seen in this patient are consistent with LV apical hypoplasia. Until now, this cardiomyopathy has been described only as an isolated congenital anomaly primarily using CMR and cardiac computed tomography. To our knowledge, this is the first reported case of LV apical hypoplasia in conjunction with another congenital cardiac abnormality, and the findings demonstrate that the distinctive appearance of this cardiomyopathy can be easily identified with echocardiography. As more cases are recognized and patients are followed over time, the natural history and optimal treatment for this cardiomyopathy may be further elucidated.
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Affiliation(s)
- Jessica A Haffajee
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston 02111 MA, USA.
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Patrianakos AP, Protonotarios N, Zacharaki A, Tsatsopoulou A, Parthenakis FI, Vardas PE. Isolated left ventricular apical hypoplasia: a newly recognized unclassified cardiomyopathy. J Am Soc Echocardiogr 2010; 23:1336.e1-4. [PMID: 20591617 DOI: 10.1016/j.echo.2010.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Indexed: 10/19/2022]
Abstract
We describe two relatively asymptomatic cases diagnosed with the newly recognized unclassified cardiomyopathy, isolated left ventricular apical hypoplasia. The disease has been described mainly in cardiac magnetic resonance, whereas this study presents the echocardiographic characteristics of this new cardiomyopathy.
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Flett AS, Elliott PM, Moon JC. Images in cardiovascular medicine. Cardiovascular magnetic resonance of isolated left ventricular apical hypoplasia. Circulation 2008; 117:e504-5. [PMID: 18574051 DOI: 10.1161/circulationaha.107.746503] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew S Flett
- Department of Cardiology, The Heart Hospital, University College London Hospitals NHS Trust, London, UK
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30
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Marin C, Sanchez ML, Maroto E, Ossaba S, Ruiz Y, Zabala JI. MR imaging of isolated left ventricular apical hypoplasia. Pediatr Radiol 2007; 37:703-5. [PMID: 17503030 DOI: 10.1007/s00247-007-0459-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 03/08/2007] [Accepted: 03/12/2007] [Indexed: 10/23/2022]
Abstract
We report the MRI findings in a 3-month-old boy with isolated left ventricular apical hypoplasia. This is a recently described congenital abnormality that consists of an odd, spherically shaped left ventricle due to absence of the ventricular apex. To our knowledge, isolated left ventricular apical hypoplasia has not been reported in a child.
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Affiliation(s)
- Carlos Marin
- Department of Paediatric Radiology, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
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31
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Dogan OF, Karcaaltincaba M, Yorgancioglu C, Demircin M, Dogan R, Ersoy U, Celiker A, Alehan D, Haliloglu M, Boke E. Demonstration of coronary arteries and major cardiac vascular structures in congenital heart disease by cardiac multidetector computed tomography angiography. Heart Surg Forum 2007; 10:E90-4. [PMID: 17311774 DOI: 10.1532/hsf98.20061013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Detection of coronary artery is important when considering surgical treatment of a congenital heart disease (CHD) such as tetralogy of Fallot (TF). Cardiac catheterization plays an important supplementary role in the evaluation of patients with CHD. In a few reports, it has been proposed that multidetector computed tomography (MDCT) can be helpful for the visualization of coronary arteries. We sought to demonstrate the feasibility and usefulness of MDCT angiography for anatomical evaluation of coronary arteries in CHD patients with suspected coronary artery anomalies. MATERIALS AND METHODS A total of 10 patients, 9 pediatric and 1 adult, underwent MDCT angiography for the investigation of coronary artery anomalies and mediastinal vascular structures. Seven patients had TF; 5 of these patients were suspected of having coronary artery anomalies and 2 were suspected of having pulmonary artery atresia or a nonconfluent pulmonary artery. The other 3 patients had truncus arteriosus and severe left pulmonary artery stenosis (n = 1), double outlet right ventricle (n = 1), and Kawasaki disease (n = 1) with suspected coronary artery aneurysms. The entire heart, major vascular structures, and coronary artery anomalies were preoperatively scanned in patients with cyanotic heart disease. Examinations were performed by 16-MDCT with 1-mm slice thickness. A breath-holding test was performed in 5 patients. Nonionic iodinated contrast material (2 cc/kg) was administered by a power injector. RESULTS Major vascular structures and the proximal part of the right and left coronary arteries were visualized successfully in all patients. Mid and/or distal segments of the coronary arteries were visualized in 5 patients with TF. Pulmonary vascular bed findings were also confirmed during surgery in patients with TF and in one patient with truncus arteriosus type I and severe left pulmonary artery stenosis. Kawasaki disease was diagnosed by the presence of aneurysms in one patient. Pulmonary artery atresia was confirmed in one patient and diameter of the pulmonary arteries (4 mm and 4.5 mm) was determined in the other 2 patients by MDCT. CONCLUSION The advantage of MDCT for cardiac imaging is the shortened scanning time for imaging the entire heart without long breath-holding times. Selective conventional coronary angiography is invasive and technically difficult in pediatric patients. We suggest that MDCT angiography can be performed as a noninvasive method in patients with CHD for the evaluation of coronary artery anatomy and anomalies and mediastinal vascular structures.
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Affiliation(s)
- Omer Faruk Dogan
- Department of Cardiovascular Surgery, Hacettepe University Medical Faculty, Ankara, Turkey.
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leonard AP, Crossley RA, Klusmann M, Roobottom CA. Cardiac multidetector computed tomography (MDCT): method, indications and applications. IMAGING 2006. [DOI: 10.1259/imaging/13060541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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