Right ventricular exclusion surgery for arrhythmogenic right ventricular dysplasia with cardiomyopathy

Management of a rare case of arrhythmogenic right ventricular dysplasia in pregnancy: a case report

Arrhythmogenic right ventricular dysplasia is a rare but not exceptional inherited cardiomyopathy characterized by fibrofatty replacement of the myocardium of the right ventricular which could lead to serious arrhythmia and sudden death. Only a few cases of pregnancies with ARVD have been reported. The aim of this case presentation is to describe the clinical characteristics and anesthetics specificities in management of this disease in pregnancy and in delivery. We report the case of a young woman aged 28 years old with a past history of ARVD treated by medical treatment with radiofrequency ablation. This patient was pregnant and it was scheduled for cesarean section delivery. Preoperative evaluation showed a well tolerated pregnancy inspite of the severity of the ARVD. It was a severe form of ARVD because of RV dilation, the spread of the disease to LV and the history of ventricular tachycardia during an attempted of ablation by radio frequency. The treatment received by the patient was kept until the day of surgery. The act took place under general anesthesia. The postoperative period was uneventful and morphine titration was used for pain relief. The patient exits the hospital 3 days after delivery and breastfeeding was forbidden. We should pay attention on this disease witch is not yet well known and witch is highly risky in the peri-partum period. Even if pregnancy may be tolerated in moderate forms of ARVD, conception and delivery sould be discouraged especially in severe forms.

Arrhythmogenic right ventricular cardiomyopathy (ARVC): case report and review of literature

Arrhythmogenic right ventricular dysplasia (ARVD) is an inherited condition characterised by fibrofatty replacement of the right ventricle. It causes sudden death in 30% of young adults and in 5% of those less than 65 years of age. As the presentation is non-specific, ARVD can be a diagnostic challenge leading to delayed treatment. We report a case along with the review of literature, of a 63-year-old man who presented (atypical) with a history of palpitations, dizziness and raised cardiac enzymes associated with ECG changes in the inferior and anterior leads. Further investigation helped in confirming this rare and potentially fatal cardiac condition.

Anaesthetic implications of arrhythmogenic right ventricular dysplasia/cardiomyopathy

Arrhythmogenic right ventricular dysplasia, also called right ventricular cardiomyopathy, is a genetically determined heart muscle disease, characterised by life-threatening ventricular arrhythmias in apparently healthy young people. The primary myocardial pathology is that the myocardium of the right ventricular free wall is replaced by fibrous or fibrofatty tissue, with scattered residual myocardial cells. Right ventricular function is abnormal and in severe cases is associated with global right ventricular dilation and overt biventricular heart failure. Although still relatively rare, arrhythmogenic right ventricular cardiomyopathy is a well recognised cause of sudden unexpected peri-operative death. In this review, we describe the basic characteristics of this disease, emphasising the diagnosis and we offer some suggestions for the anaesthetic management of these patients in the peri-operative period.