1
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Wilinski MS, Porter IM. Idiopathic Left Ventricular Apical Aneurysm in a Sailor With Moderate Transient Chest Pain: A Unique Perspective on an Atypical Presentation in the Military Population. Mil Med 2023; 188:e3707-e3710. [PMID: 37002878 DOI: 10.1093/milmed/usac416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/24/2022] [Accepted: 12/15/2022] [Indexed: 11/09/2023] Open
Abstract
Left ventricular (LV) apical aneurysm is a rare condition that carries a high risk of fatal cardiac rupture. Wall ruptures are an uncommon catastrophic complication after acute transmural myocardial infarction. Rarely is the rupture only contained by an adherent pericardium or hematoma creating a pseudoaneurysm. This clinical finding calls for emergent surgical intervention. If no ruptures are detectable and myocardium wall integrity is verified, the diagnosis of a true aneurysm can be made to be repaired via elective surgery. The etiological differential for a patient with an LV aneurysm in the setting of normal coronaries and in the absence of prior cardiac surgery remains broad, including traumatic, infectious, and infiltrative causes. In this case report, we demonstrate an atypical and rare presentation of an idiopathic LV apical aneurysm in a physically fit, active duty male in the U.S. Navy.
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Affiliation(s)
- Michael S Wilinski
- Department of Aviation Medicine, Naval Branch Health Clinic Mayport, Jacksonville, FL 32228, USA
| | - Ian M Porter
- Department of Aviation Medicine, Naval Branch Health Clinic Mayport, Jacksonville, FL 32228, USA
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2
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Jolobe OM. High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics. IJC HEART & VASCULATURE 2023; 47:101221. [PMID: 37252195 PMCID: PMC10209807 DOI: 10.1016/j.ijcha.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
In this narrative review of cardiac sarcoidosis, based on a literature search using the terms "cardiac sarcoidosis", "tuberculous myocarditis", "Whipple's disease and myocarditis", and"idiopathic giant cell myocarditis", I have defined cardiac sarcoidosis as a disorder which can be diagnosed either by documentation of the presence of sarcoid-related granulomas in myocardial tissue or by documentation of the association of the presence of sarcoid-related granulomas in extracardiac tissue and symptoms such as complete heart block, ventricular tachyarrhythmia, sudden death or dilated cardiomyopathy which are typical of cardiac sarcoidosis. The differential diagnosis of cardiac sarcoidosis includes granulomatous myocarditis attributable to underlying causes such as such as tuberculosis, Whipple's disease, and idiopathic giant cell myocarditis. Diagnostic pathways for cardiac sarcoidosis include biopsy of cardiac and extracardiac tissue, nuclear magnetic resonance imaging, positron emission tomography, and a diagnostic trial of empiric therapy. Problem areas include differentiation between noncaseating granulomatosis attributable to sarcoidosis versus noncaseating granulomatosis attributable to tuberculosis and whether or not the workup of suspected cardiac sarcoidosis should always include evaluation of biopsy tissue by molecular methods for M tuberculosis DNA as well as by mycobacterium tuberculosis culture. The diagnostic significance of necrotising granulomatosis is also unclear. Evaluation of patients on long term immunotherapy should also take due account of the risk of tuberculosis attributable to the use of tumor necrosis factor-alpha antagonists.
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Affiliation(s)
- Oscar M.P. Jolobe
- Address: Flat 6 Souchay Court, 1 Clothorn Road, Manchester M20 6BR, United Kingdom.
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3
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Chang H, Kuo L, Sung S, Weng C, Chen C, Niu D, Chen S, Yu W. Left Ventricular Apical Aneurysm in Fabry Disease: Implications for Clinical Significance and Risk Stratification. J Am Heart Assoc 2022; 12:e027041. [PMID: 36583432 PMCID: PMC9973567 DOI: 10.1161/jaha.122.027041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background A previously underrecognized phenotype of left ventricular apical aneurysm (LVAA) has been increasingly identified in Fabry disease. This study explored LVAA's clinical prevalence and its prognostic implications over a long-term follow-up. Methods and Results We retrospectively analyzed 268 consecutive patients with Fabry disease at a tertiary medical center. Patients with increased left ventricular mass index were recognized as having left ventricular hypertrophy (LVH). LVAA was identified using either echocardiography or cardiovascular magnetic resonance imaging. Two patients with ischemic LVAA were excluded. The primary end point was a composite of cardiovascular events, including heart failure hospitalization, sustained ventricular tachycardia, ischemic stroke, and all-cause mortality. Of 266 enrolled patients, 105 (39.5%) had LVH (age 58.5±11.9 years, 48.6% men), and 11 (10.5%) had LVAA. Over 49.3±34.8 months of follow-up, 25 patients with LVH experienced composite events, including 9 heart failure hospitalizations, 4 sustained ventricular tachycardia, 6 ischemic strokes, and 15 mortalities. In patients with LVH, those with LVAA had a significantly higher risk of composite events and lower event-free survival than those without LVAA (8 [72.7%] versus 17 [18.1%], log-rank P<0.001). LVAA was independently associated with an increased risk of composite events (hazard ratio, 3.59 [95% CI, 1.30-9.91]; P=0.01) after adjusting for age, sex, advanced heart failure, renal function, dyslipidemia, atrial fibrillation, left ventricular ejection fraction, left ventricular diastolic function, and left ventricular mass index. Conclusions LVAA is present in approximately 10% of patients with Fabry disease and LVH. It is associated with an increased risk of adverse cardiovascular events and may necessitate aggressive treatment.
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Affiliation(s)
- Hao‐Chih Chang
- Department of MedicineTaipei Veterans General Hospital Yuanshan and Suao BranchYilanTaiwan,Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Internal MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ling Kuo
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Internal MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Shih‐Hsien Sung
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Internal MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Ching‐Yao Weng
- Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan
| | - Chun‐Ku Chen
- Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan,Department of RadiologyCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Dau‐Ming Niu
- Department of PediatricsTaipei Veterans General HospitalTaipeiTaiwan
| | - Shih‐Ann Chen
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Internal MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan,Cardiovascular CenterTaichung Veterans General HospitalTaichungTaiwan
| | - Wen‐Chung Yu
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan,Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Department of Internal MedicineCollege of Medicine, National Yang Ming Chiao Tung UniversityTaipeiTaiwan
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4
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Kim SJ, Ann SH, Kim YG, Park S. Left Ventricular Apical Aneurysm: Atypical Feature of Cardiac Sarcoidosis Diagnosed by Multimodality Imaging. Korean Circ J 2021; 52:169-171. [PMID: 35043609 PMCID: PMC8819573 DOI: 10.4070/kcj.2021.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/28/2021] [Accepted: 11/17/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shin-Jae Kim
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
| | - Soe Hee Ann
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Yong-Giun Kim
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sangwoo Park
- Division of Cardiology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
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5
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Akamatsu K, Ito T, Terasaki F, Hoshiga M. Myocardial findings evaluated by echocardiography in cardiac sarcoidosis: A report of seven cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:940-946. [PMID: 34431526 DOI: 10.1002/jcu.23058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause. With cardiac sarcoidosis (CS), patients represent a wide range of cardiac manifestations from subtle to overt morphological and functional abnormalities. The advent of ultrasound technologies has enabled to identify not only typical findings to CS such as basal thinning of the ventricular septum, but also subclinical myocardial alterations. Based on our recent experiences, we currently introduce a variety of myocardial manifestations evaluated by echocardiography on seven CS patients being selected. Most of the patients exhibited typical cardiac involvement and the remaining fairly unusual.
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Affiliation(s)
- Kanako Akamatsu
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Fumio Terasaki
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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6
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Kitaoka H, Tsutsui H, Kubo T, Ide T, Chikamori T, Fukuda K, Fujino N, Higo T, Isobe M, Kamiya C, Kato S, Kihara Y, Kinugawa K, Kinugawa S, Kogaki S, Komuro I, Hagiwara N, Ono M, Maekawa Y, Makita S, Matsui Y, Matsushima S, Sakata Y, Sawa Y, Shimizu W, Teraoka K, Tsuchihashi-Makaya M, Ishibashi-Ueda H, Watanabe M, Yoshimura M, Fukusima A, Hida S, Hikoso S, Imamura T, Ishida H, Kawai M, Kitagawa T, Kohno T, Kurisu S, Nagata Y, Nakamura M, Morita H, Takano H, Shiga T, Takei Y, Yuasa S, Yamamoto T, Watanabe T, Akasaka T, Doi Y, Kimura T, Kitakaze M, Kosuge M, Takayama M, Tomoike H. JCS/JHFS 2018 Guideline on the Diagnosis and Treatment of Cardiomyopathies. Circ J 2021; 85:1590-1689. [PMID: 34305070 DOI: 10.1253/circj.cj-20-0910] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | | | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Kyushu University
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine, Kanazawa University, Graduate School of Medical Science
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Chizuko Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
| | - Seiya Kato
- Division of Pathology, Saiseikai Fukuoka General Hospital
| | | | | | | | - Shigetoyo Kogaki
- Department of Pediatrics and Neonatology, Osaka General Medical Center
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | | | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama International Medical Center, Saitama Medical University
| | - Yoshiro Matsui
- Department of Cardiac Surgery, Hanaoka Seishu Memorial Hospital
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Satoshi Hida
- Department of Cardiovascular Medicine, Tokyo Medical University
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshiro Kitagawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yoji Nagata
- Division of Cardiology, Fukui CardioVascular Center
| | - Makiko Nakamura
- Second Department of Internal Medicine, University of Toyama
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hitoshi Takano
- Department of Cardiovascular Medicine, Nippon Medical School Hospital
| | - Tsuyoshi Shiga
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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7
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Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J 2019; 83:2329-2388. [PMID: 31597819 DOI: 10.1253/circj.cj-19-0508] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumio Terasaki
- Medical Education Center / Department of Cardiology, Osaka Medical College
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobukazu Ishizaka
- Department of Internal Medicine (III) / Department of Cardiology, Osaka Medical College
| | - Yoshio Ishida
- Department of Internal Medicine, Kaizuka City Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takatomo Nakajima
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | - Taiko Horii
- Department of Cardiovascular Surgery, Kagawa University School of Medicine
| | | | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tohru Ohe
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yoshihiko Saito
- Department of Cardiorenal Medicine and Metabolic Disease, Nara Medical University
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
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8
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Multiple left ventricular aneurysms in a young female. Rev Port Cardiol 2016; 35:113.e1-6. [PMID: 26852308 DOI: 10.1016/j.repc.2015.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 07/18/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
Multiple left ventricular aneurysms (LVAs) are rare, especially in a young female. A 29-year-old woman presented vague symptoms. Multiple LVAs were revealed and confirmed on different imaging modalities, including chest radiography, echocardiography, contrast ventriculography and cardiac magnetic resonance imaging. Detailed work-up for probable etiologies including ischemic, infectious, inflammatory and autoimmune causes was negative. In the absence of angina, decompensated congestive heart failure, arrhythmias and embolism, the patient was managed conservatively, with excellent mid-term outcome.
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9
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Multiple left ventricular aneurysms in a young female. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy. Case Rep Cardiol 2015; 2015:625451. [PMID: 26448882 PMCID: PMC4581496 DOI: 10.1155/2015/625451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 08/27/2015] [Indexed: 12/27/2022] Open
Abstract
Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is
a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later.
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11
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Isobe M. [The Cutting-edge of Medicine; Clinical features of isolated cardiac sarcoidosis]. ACTA ACUST UNITED AC 2015; 104:120-7. [PMID: 26571786 DOI: 10.2169/naika.104.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Isobe M, Tezuka D. Isolated cardiac sarcoidosis: clinical characteristics, diagnosis and treatment. Int J Cardiol 2014; 182:132-40. [PMID: 25577749 DOI: 10.1016/j.ijcard.2014.12.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.
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Affiliation(s)
- Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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13
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Clinical characteristics of definite or suspected isolated cardiac sarcoidosis: application of cardiac magnetic resonance imaging and 18F-Fluoro-2-deoxyglucose positron-emission tomography/computerized tomography. J Card Fail 2014; 21:313-22. [PMID: 25512195 DOI: 10.1016/j.cardfail.2014.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 11/27/2014] [Accepted: 12/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Isolated cardiac sarcoidosis (iCS) is difficult to diagnose in patients without histologic evidence of sarcoidosis. We aimed to clarify the clinical characteristics of iCS, including imaging features on cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron-emission tomography/computerized tomography (FDG-PET/CT) scans. We also reviewed the therapeutic effect of corticosteroids and determined the long-term prognosis. METHODS AND RESULTS We retrospectively reviewed 83 consecutive patients with suspicious CS from 1997 to 2013. Systemic sarcoidosis with CS (sCS, n = 30) and iCS (n = 11) were diagnosed according to clinical criteria. In iCS cases, sarcoidosis was not detected in any other organs. The clinical features did not significantly differ between sCS and iCS cases, except for ejection fraction, which was lower in iCS (P = .025). Nine sCS and 4 iCS cases showed late gadolinium enhancement, and the lesions tended to be on the epicardial side (76.9% P = .011) and septal wall (52.9% P < .001). The coefficient of variance for the myocardial standardized uptake value of FDG-PET/CT was higher in sCS (0.32 ± 0.13; n = 19) and iCS (0.32 ± 0.09; n = 7) than in control cases (n = 31; P < .001). B-Type natriuretic peptide level was improved after prednisolone treatment in both groups. Kaplan-Meier curve indicated that prognosis was not different between sCS and iCS cases. CONCLUSIONS The clinical cardiac characteristics of iCS cases were similar to those of sCS. Cardiac MRI and FDG-PET, noninvasive imaging modalities, could be useful modalities to detect myocardial involvement in the cases with definite or suspected iCS.
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14
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Presence of ventricular aneurysm predicts poor clinical outcomes in patients with cardiac sarcoidosis. Int J Cardiol 2014; 177:720-2. [DOI: 10.1016/j.ijcard.2014.10.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
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15
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Tezuka D, Isobe M. [Cardiomyopathy: progress in diagnosis and treatments. Topics: II. Secondary cardiomyopathy; 2. Cardiac sarcoidosis]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2014; 103:299-308. [PMID: 24724370 DOI: 10.2169/naika.103.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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16
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Segura AM, Radovancevic R, Demirozu ZT, Frazier O, Buja LM. Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist device. Cardiovasc Pathol 2014; 23:17-20. [DOI: 10.1016/j.carpath.2013.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023] Open
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17
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18
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Miyahara S, Mukohara N, Morimoto N, Murakami H, Nakagiri K, Yoshida M. Left ventricular restoration for cardiac sarcoidosis: report of two cases. Surg Today 2012; 44:568-71. [PMID: 23271666 DOI: 10.1007/s00595-012-0409-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/19/2012] [Indexed: 11/24/2022]
Abstract
Although sarcoidosis may involve the myocardium, there is little available information on its treatment, especially in cases requiring surgery, such as left ventricular restoration or mitral valve repair. This report presents two surgical cases with cardiac sarcoidosis treated by left ventricular restoration and mitral valve repair for a ventricular aneurysm and dilated cardiomyopathy with mitral regurgitation.
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Affiliation(s)
- Shunsuke Miyahara
- Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Hyogo, Japan,
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19
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Chapelon-Abric C. Cardiac sarcoidosis. Presse Med 2012; 41:e317-30. [DOI: 10.1016/j.lpm.2012.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 12/27/2022] Open
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20
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Masuno T, Hirata K, Wada N, Endo H, Takemoto K, Nishiguchi T, Teraguchi I, Maniwa N, Shimokado A, Kashiwagi M, Tsujioka H, Ikejima H, Kuroi A, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Kitabata H, Kimura K, Imanishi T, Akasaka T. Left ventricular apical aneurysm due to unrecognized sarcoidosis. J Echocardiogr 2010; 8:129-30. [PMID: 27278945 DOI: 10.1007/s12574-010-0046-9] [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: 03/23/2010] [Revised: 04/21/2010] [Accepted: 04/24/2010] [Indexed: 11/30/2022]
Abstract
A 47-year-old woman was hospitalized for syncope. An electrocardiogram showed complete right bundle branch block and T-wave inversion in leads III, aVF, and V2-4. Cardiac catheterization was performed since the echocardiogram demonstrated the existence of a left ventricular apical aneurysm and apical thrombus. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsied specimen from the right ventricular apical wall demonstrated typical noncaseating granulomas with giant cells. There was no evidence suggesting the involvement of other systemic organs. The patient was diagnosed as having cardiac sarcoidosis. Cardiac sarcoidosis should be considered within a spectrum of diseases that cause left ventricular apical aneurysm.
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Affiliation(s)
- Tomizo Masuno
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kumiko Hirata
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Nozomi Wada
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Haruka Endo
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kazushi Takemoto
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Tsuyoshi Nishiguchi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Ikuko Teraguchi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Naoki Maniwa
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Aiko Shimokado
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Manabu Kashiwagi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Hiroto Tsujioka
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Hideyuki Ikejima
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Akio Kuroi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kohei Ishibashi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Kenichi Komukai
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Tanimoto
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Yasushi Ino
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Hironori Kitabata
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Keizo Kimura
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Toshio Imanishi
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Takashi Akasaka
- Internal Medicine, Division of Cardiovascular Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
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Retinal macroaneurysm associated with ocular sarcoidosis. Jpn J Ophthalmol 2010; 54:392-5. [PMID: 21052899 DOI: 10.1007/s10384-010-0847-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 03/25/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To characterize retinal macroaneurysm, which although rare, has been reported as a specific complication of ocular sarcoidosis. METHODS Ninety-seven sarcoidosis patients with intraocular inflammation diagnosed at the Uveitis Clinic of Tokyo Medical University Hospital between 1997 and 2006 were analyzed retrospectively. RESULTS Retinal macroaneurysm was found in nine eyes of seven patients (7.2%). The mean patient age at onset was 61 years, similar to the reported onset age in patients with macroaneurysm not associated with ocular sarcoidosis. Most aneurysms developed in the chronic phase, and not in the early phase, of ocular sarcoidosis. Two patients (29%) were affected bilaterally. Five of nine eyes (56%) had multiple lesions. Unlike retinal macroaneurysm not associated with sarcoidosis, which is usually solitary and unilateral, rates of bilateral and multiple lesions were high. CONCLUSIONS The clinical features of retinal aneurysm associated with ocular sarcoidosis are considerably different from those of unilateral macroaneurysm not associated with sarcoidosis.
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Shudong X, Bifeng W, Xiaolian Z, Xiaosheng H. Left ventricular aneurysm in patients with idiopathic dilated cardiomyopathy: clinical analysis of six cases. Neth Heart J 2010. [DOI: 10.1007/s12471-010-0006-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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23
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Unusual cardiovascular manifestations of sarcoidosis, a report of three cases: coronary artery aneurysm with myocardial infarction, symptomatic mitral valvular disease, and sudden death from ruptured splenic artery. Cardiovasc Pathol 2010; 19:e119-23. [DOI: 10.1016/j.carpath.2009.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Revised: 03/24/2009] [Accepted: 04/14/2009] [Indexed: 11/18/2022] Open
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24
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Isselbacher EM, Kligerman SJ, Lam KM, Hurtado RM. Case records of the Massachusetts General Hospital. Case 2-2010. A 47-year-old man with abdominal and flank pain. N Engl J Med 2010; 362:254-62. [PMID: 20089976 DOI: 10.1056/nejmcpc0905548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eric M Isselbacher
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, USA
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25
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Xia S, Wu B, Zhang X, Hu X. Left ventricular aneurysm in patients with idiopathic dilated cardiomyopathy: clinical analysis of six cases. Neth Heart J 2009; 17:475-80. [PMID: 20087451 PMCID: PMC2804080 DOI: 10.1007/bf03086307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background. Left ventricular aneurysm (LVA) in patients with idiopathic dilated cardiomyopathy (IDCM) is rarely reported, and the incidence, pathogenesis and clinical features of LVA in IDCM are poorly understood.Methods. The diagnosis of IDCM with LVA formation was made in six patients between January 2003 and September 2008. Left ventriculography, coronary angiography, echocardiogram and electrocardiogram were performed in all patients. The hospital records of these patients with IDCM in our hospital and related literature were reviewed.Results. LVA was located at the posterobasal wall in five patients and at the anterolateral wall in one patient. Two patients had abnormal Q waves and no patients had sustained ST-segment elevation on electrocardiogram. No significant coronary stenosis or mural thrombi was detected in these patients. All patients had severe ventricular arrhythmia, such as frequent multifocal ventricular premature contractions and ventricular tachycardia.Conclusion. IDCM could be a rare cause of LVA. The LVA in IDCM was mainly located at the posterobasal wall. It was seldom accompanied by abnormal Q waves and sustained ST-segment elevation. The pathogenesis of LVA in IDCM seems to be less likely to be related to coronary emboli. Ventricular arrhythmia occurred frequently in these patients. (Neth Heart J 2009;17:475-80.).
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Affiliation(s)
- Shudong Xia
- Department of Cardiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y, Ohkawa K, Maruhashi T, Kagawa E, Dai K, Aokage T. Variant form of tako-tsubo cardiomyopathy. Int J Cardiol 2007; 119:e56-8. [PMID: 17459500 DOI: 10.1016/j.ijcard.2007.01.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2006] [Accepted: 01/05/2007] [Indexed: 11/21/2022]
Abstract
We report a female case of variant form of tako-tsubo cardiomyopathy in which wall motion of the distal segment was preserved. In the current case, left ventriculography showed akinesia of the mid portion and normokinesia of the distal and basal portions of the left ventricular chamber. ST-segment elevation was obvious in leads V1-3 rather than in leads V4-6. Because ST-segment elevation is absent in left precordial leads, cardiologists should take care not to fail to diagnose variant form of tako-tsubo cardiomyopathy.
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Paul M, Schäfers M, Grude M, Reinke F, Juergens KU, Fischbach R, Schober O, Breithardt G, Wichter T. Idiopathic left ventricular aneurysm and sudden cardiac death in young adults. ACTA ACUST UNITED AC 2006; 8:607-12. [PMID: 16864613 DOI: 10.1093/europace/eul074] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIMS We report three young patients presenting with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) and/or survived sudden cardiac arrest, who were admitted to our institution for further diagnostic evaluation. METHODS AND RESULTS In all patients, idiopathic left ventricular (LV) aneurysms were identified after a detailed non-invasive and invasive evaluation. Sustained VT/VF was inducible during programmed ventricular stimulation in two of the three patients. Left ventricular aneurysms were depicted and characterized by various imaging modalities (echocardiography, magnetic resonance imaging, LV angiography). To elucidate the pathogenesis further, both myocardial viability and regional sympathetic innervation were assessed by radionuclide imaging techniques. Defects of innervation and metabolism were documented in the area of the aneurysm but distal to the aneurysm there were no signs of downstream denervation. CONCLUSION Life-threatening arrhythmias may be the first manifestation of an idiopathic LV aneurysm, which can be reliably diagnosed with modern imaging techniques. Radionuclide imaging may yield additional information as to the involvement of the autonomic nervous system potentially associated with arrhythmogenesis. Management strategies in patients with an idiopathic LV aneurysm range from antiarrhythmic drug treatment, implantation of an automatic cardioverter-defibrillator to surgical aneurysmectomy.
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Affiliation(s)
- Matthias Paul
- Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany.
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29
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Haraki T, Ueda K, Shintani H, Hayashi T, Taki J, Mabuchi H. Spontaneous development of left ventricular aneurysm in a patient with untreated cardiac sarcoidosis. Circ J 2002; 66:519-21. [PMID: 12030352 DOI: 10.1253/circj.66.519] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A young adult patient with untreated sarcoidosis spontaneously developed a left ventricular (LV) aneurysm in the anterolateral free wall. Single-photon emission computed tomography (SPECT) using Gallium-67 clearly demonstrated widespread abnormal uptake, including the LV aneurysm. Thallium-201 SPECT revealed a perfusion defect in the anterolateral wall, and abnormal uptake of technetium-99m pyrophosphate was seen, especially in the borders of the defect lesion.
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Affiliation(s)
- Tatsuo Haraki
- Department of Internal Medicine, Komatsu Municipal Hospital, Japan.
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30
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Chiu CZ, Cheng JJ, Nakatani S, Yamagishi M, Miyatake K. Echocardiographic Manifestations in Patients with Cardiac Sarcoidosis. J Med Ultrasound 2002. [DOI: 10.1016/s0929-6441(09)60031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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