1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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
| | | |
Collapse
|
4
|
Ramamurthy HR, Auti O, Raj V, Viralam K. Isolated left ventricular apical hypoplasia in a young child. BMJ Case Rep 2021; 14:14/1/e239297. [PMID: 33509886 PMCID: PMC7845721 DOI: 10.1136/bcr-2020-239297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A 16-month-old, healthy, asymptomatic male child presented with a diagnosis of dilated cardiomyopathy. Cardiovascular examination and chest radiograph were normal. ECG revealed sinus rhythm, and the augmented vector left lead showed raised ST segment, T wave inversion and q waves. Echocardiography showed a globular left ventricle with notched cardiac apex, abnormal echogenicity in the left ventricular apical myocardium, single papillary muscle and normal biventricular function. Cardiac MRI scan revealed a globular left ventricle with fibrofatty changes and retraction of the apex, the papillary muscles closely approximated, and the right ventricle wrapping around the apex of the left ventricle. This is described as isolated left ventricular apical hypoplasia. Diagnosis of this rare entity can be made by MRI, and it has been diagnosed largely in adults. The pathophysiology and long-term outcomes are unknown. We characterise the echocardiography findings of this rare anomaly in a child for the first time in the literature.
Collapse
Affiliation(s)
- H Ravi Ramamurthy
- Department of Pediatrics, Army Hospital (Research & Referral), Delhi, India,Department of Pediatric Cardiology & Grown Up congenital heart diseases, Narayana Institute of Cardiac Sciences, Bangalore, India
| | - Onkar Auti
- Department of Radiology, Ruby Hall Clinic, Pune, India
| | - Vimal Raj
- Department of Radiology, Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, India
| | - Kiran Viralam
- Department of Pediatric and Grown-UpCongenital HeartDiseases, Narayana Institute of Cardiac Sciences, Bangalore, India
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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
| |
Collapse
|
12
|
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.
Collapse
Affiliation(s)
- Jin Il Moon
- Department of Radiology, Medical Research Institute, Pusan National University Hospital, Busan 602-739, Korea
| | | | | | | | | |
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Kristine D Tumabiene
- Section of Cardiology, University of the Philippines-Philippine General Hospital (UP-PGH), Manila, Philippines.
| | | | | | | | | | | |
Collapse
|
14
|
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.
Collapse
Affiliation(s)
- Thomas E Vanhecke
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI, USA.
| | | | | | | |
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Jessica A Haffajee
- Cardiovascular Imaging and Hemodynamic Laboratory, Tufts Medical Center, Boston 02111 MA, USA.
| | | | | | | | | |
Collapse
|
16
|
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.
Collapse
|