Cardiomyopathy in four members of a family

Naxos disease: from the origin to today

Naxos disease, first described by Dr. Nikos Protonotarios and colleagues on the island of Naxos, Greece, is a special form of arrhythmogenic right ventricular dysplasia (ARVD). It is an inherited condition with a recessive form of transmission and a familial penetrance of 90%. It is associated with thickening of the skin of the hands and sole, and a propensity to woolly hair. The cardiac anomalies characterized by ventricular arrhythmias with ventricular extrasystoles and tachycardia and histologic features of the myocardium are consistent with ARVD, but in a more severe form of dysplasia with major dilatation of the right ventricle. The identification of the responsible first gene on chromosome 17, and its product plakoglobin as the responsible protein for Naxos disease proved to be a milestone in the study of ARVD, which opened a new field of research. Thanks to those with the determination to discover Naxos disease, there is and will be more clarity in understanding the mechanisms of juvenile sudden death in the young who have an apparently otherwise normal heart.

Morphological observation of idiopathic cardiomyopathy consisting of 9 cases encountered in sudden and unexpected death

The present study consists of 9 cases of idiopathic cardiomyopathy which were divided into two types, i.e. 6 cases of the hypertrophic type and 3 cases of the dilated type. The former type was found in school-children and relatively younger adults, and the latter in various ages. In both types the hearts showed marked enlargement. The characteristic gross changes of the hypertrophic type were hypertrophy of the anterior wall of left ventricle and of the ventricular septum. Microscopically, the hypertrophied myocardium demonstrated a bizarre arrangement showing different size and shape of muscle fibers. In addition, the wall of small arteries and arterioles revealed circumscribed elastosis here and there. In the dilated type, the hearts showed marked dilatation of both ventricles, and microscopy revealed coagulation necrosis of the myocardial fibers and marked scar formation with slight inflammatory cell infiltration. The gross and microscopic changes in both types of idiopathic cardiomyopathy differed from one another in several respects, and the authors assumed that the differences indicate an independent etiology of both types in man.

The clinical course of primary myocardial disease in infants and children

A total of 161 infants and children, ranging in age from 1 day to 17 years at initial encounter (mean, 3.7 years), was seen over a 30 year period with primary myocardial disease (idiopathic myocarditis, nonobstructive cardiomyopathy, endocardial fibroelastosis, and an anatomically unknown category). These patients were observed from 1 hour to 23 years after initial encounter and cardiac disease has resolved in 27 per cent, resulted in death in 35 per cent, and continues in 38 per cent. The majority were first referred to us with congestive heart failure; all exhibited ST-T changes and cardiomegaly, 67 of 150 had left ventricular hypertrophy, 23 of 151 arrhythmias, and 55 of 153 pulmonary vascular congestion. Initial ventricular depolarization abnormalities were very frequent. Significant clinical predictors of fatal outcome included pulmonary vascular congestion, "northwest" axis deviation, and a cardiac index less than three L./min./M.2. Death occurred during the first year after initial encounter in 44 of 57 who died, and in all 13 with proved myocarditis. Primary myocardial disease is a serious disease of infancy and childhood, resulting in death or residual cardiac disease in three fourths of those affected.

Hypertrophic cardiomyopathy with unusual features in a family

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Hypertrophic subaortic stenosis with myocardial fibre degeneration

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