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Mohamed OAM, El-Dardeery M, Zayed K, Mosaad E, Abdulwahhab MM, Romeih S. Uhl's Anomaly in Adulthood. World J Pediatr Congenit Heart Surg 2024; 15:523-525. [PMID: 38693789 DOI: 10.1177/21501351241236720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Uhl's anomaly is a rare congenital syndrome characterized by the absence of right ventricular myocardium. The widely accepted pathological mechanism is intrauterine myocardial apoptosis. Uhl's syndrome carries a poor prognosis. In rare situations, patients with Uhl's anomaly reach adulthood. We will present a case of a 29-year-old patient with Uhl's syndrome treated at our center, highlighting the diagnostic, surgical, and postoperative challenges in management.
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Affiliation(s)
- Omar A M Mohamed
- Department of Critical Care Medicine, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
| | - Marwa El-Dardeery
- Department of Adult Congenital Heart Disease, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
| | - Kareem Zayed
- Department of Cardiac Surgery, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
| | - Eleia Mosaad
- Department of Critical Care Medicine, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
| | - Muhammad M Abdulwahhab
- Department of Critical Care Medicine, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
| | - Soha Romeih
- Department of Adult Congenital Heart Disease, Magdi Yacoub Heart Foundation, Aswan Heart Center, Aswan, Egypt
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Sherer DM, Choudharry M, De León-Perazza M, Zigalo A, Kheyman M, Dalloul M. Prenatal sonographic findings of prominent fetal tricuspid annulus: A case report. Radiol Case Rep 2024; 19:661-664. [PMID: 38111557 PMCID: PMC10726334 DOI: 10.1016/j.radcr.2023.10.079] [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: 09/30/2023] [Revised: 10/25/2023] [Accepted: 10/29/2023] [Indexed: 12/20/2023] Open
Abstract
The tricuspid valve positioned between the right atrium and right ventricle is composed of 3 leaflets (anterior, posterior, and septal) anchored by a collagenous fibrous annulus, a saddle-shaped, oval structure, providing a firm yet dynamic structural support for the tricuspid valve. The annulus is considered to separate between the right atrium and right ventricle. Structural anomalies of the fetal tricuspid valve are rare and include Ebstein's anomaly, tricuspid atresia, partial absence, unguarded tricuspid orifice (absent leaflets) cleft, double orifice, bicuspid valve and Uhl anomaly (absence of the right ventricular myocardium with an apposing endocardium and epicardium). We present an unusual case in which a prominent peripheral circular structure was noted above the periphery of the fetal tricuspid valve at 31 weeks' gestation. Inflow across the tricuspid valve was unimpaired, with no tricuspid regurgitation. The right atrium appeared normal with a normal functioning foramen ovale, and the entire fetal cardiac anatomy and function were normal with no signs of congestive cardiac failure or fetal hydrops. The prominent non-obstructing circular structure in immediate proximity to the tricuspid valve leaflets was considered to represent a prominent tricuspid annulus. An appropriate for gestational age fetus was delivered at term and neonatal echocardiography was normal. This case emphasizes that normal variations in fetal anatomical structures should always be considered and specifically that unimpaired inflow across the tricuspid valve in diastole is key upon encountering an unusually prominent fetal tricuspid annulus, which may be noted at a considerable distance above the tricuspid leaflets within the right atrium.
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Affiliation(s)
- David M. Sherer
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
| | - Maryam Choudharry
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
| | - Monica De León-Perazza
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
| | - Aleksandra Zigalo
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
| | - Mila Kheyman
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
| | - Mudar Dalloul
- The Division of Maternal Fetal Medicine, The Department of Obstetrics and Gynecology, State University of New York (SUNY), Downstate Health Sciences University, 450 Clarkson Ave, Box 24, Brooklyn, NY, USA
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Mohanty V, Sharma SK, Goswami S, Gudhage R, Deora S. Idiopathic Isolated Right Ventricular Cardiomyopathy: A Rare Case Report. Avicenna J Med 2023; 13:56-59. [PMID: 36969354 PMCID: PMC10038749 DOI: 10.1055/s-0043-1764376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
Idiopathic isolated right ventricular cardiomyopathy is an extremely rare cause of right ventricular failure. Here, we report a case of 65-year-old male presented with chief complaints of dyspnea, fatigue, and bilateral pedal edema for the last 6 months. On clinical evaluation, grade II/III pansystolic murmur was present in left parasternal area. Investigations and imaging revealed dilated right atrium and ventricle with normal pulmonary artery pressure without any etiology. Magnetic resonance imaging ruled out other common causes of right ventricular cardiomyopathy; thus, the patient was diagnosed as a case of idiopathic isolated right ventricular cardiomyopathy that is a diagnosis of exclusion.
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Affiliation(s)
- Vivek Mohanty
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Shubham Kumar Sharma
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sourabh Goswami
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rahul Gudhage
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
- Address for correspondence Surender Deora, MD, DM, FACC, FCSI Department of Cardiology, Room No 3131, All India Institute of Medical SciencesJodhpur 342005, RajasthanIndia
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Combined Heart and Liver Transplantation for Uhl's Anomaly: A Case Report. Transplant Proc 2021; 53:2751-2753. [PMID: 34593248 DOI: 10.1016/j.transproceed.2021.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Uhl's anomaly is an extremely rare congenital heart defect characterized by absence of the right ventricle myocardium and preserved left ventricular myocardium. Although the disease has a poor prognosis and is generally fatal in the perinatal period, some patients may reach adulthood. METHODS We describe a case of Uhl's anomaly complicated with heart failure and decompensated cardiac cirrhosis in a 42-year-old man treated by combined heart-liver transplant. RESULTS The patient underwent heart transplant using the bicaval technique followed by subsequent liver transplant with the piggyback technique without venovenous bypass. Total ischemia time was 108 minutes for the heart and 360 and 25 minutes of cold and warm ischemia, respectively, for the liver. No intraoperative complications occurred. The patient was discharged without severe complications on postoperative day 22. Pathologic examination of the organs reported advanced cirrhosis of the liver and severe dilated myocardiopathy of right ventricle with absence of myocardium and a normal left ventricle. Twenty-seven months after the transplant the patient has been free from hospital admissions, with normal function of both transplanted organs. CONCLUSIONS We report the first successful combined heart-liver transplant for Uhl's anomaly indication in an adult patient. Despite of the insufficient knowledge of natural history of this exceptional disease, we successfully apply the management principles of other end-stage right heart disorders complicated with liver failure.
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Caruso S, Cannataci C, Romano G. Case 288: Uhl Anomaly. Radiology 2021; 299:237-241. [PMID: 33750225 DOI: 10.1148/radiol.2021192475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
History A 46-year-old woman was admitted to our hospital with decompensated congestive heart failure and pericardial effusion diagnosed at echocardiography. She had no family history of sudden cardiac death. She was born at term and experienced no cardiac events until 4 years of age, at which point she was hospitalized because of three syncopal episodes that were not related to exercise. Over the next 10 years, she experienced two additional episodes of syncope not related to exercise. She had another hospital admission at 12 years of age. Clinical examination did not reveal cyanosis or clubbing, peripheral pulses were normal, and blood pressure was 90/60 mmHg. Her venous pressure was elevated, but the liver was not enlarged, and the lung fields were clear. Electrocardiography showed sinus rhythm, right bundle branch block, T-wave inversion in V6, and evidence of right atrial dilatation. Two-dimensional echocardiography showed normal intracardiac connections, with the tricuspid valve in the normal position and normal size of the left atrium and left ventricle with a normal ejection fraction. The right ventricle (RV) was dilated, without evidence of RV outflow tract obstruction. Implantation of an implantable cardioverter-defibrillator was considered but was ultimately contraindicated because of RV anatomy. Thus, the patient received conservative care and was started on digoxin and diuretics. At 32 years of age, she experienced an episode of atrial flutter that was treated with electrical cardioversion. As stated earlier, at 46 years of age, she was admitted to our hospital with decompensated heart failure to be evaluated for a heart transplant. She underwent electrocardiography, echocardiography, cardiac MRI with and without administration of contrast media, and non-cardiac-gated multidetector CT (MDCT) with and without contrast media to rule out pulmonary embolism. The following quantitative results were obtained with MRI: Left ventricular end-diastolic volume (LVDV) was 40 mL (LVDV per body surface area [BSA], 25 mL/m2); left ventricular end-systolic volume (LVSV), 21 mL (LVSV/BSA, 13 mL/m2); left ventricular stroke volume (SV), 19 mL (SV/BSA, 12 mL/m2); and left ventricular ejection fraction, 47%. RV end-diastolic volume (RVDV) was 262 mL (RVDV/BSA, 164 mL/m2); RV end-systolic volume (RVSV), 198 mL (RVSV/BSA, 124 mL/m2); RV stroke volume (SV), 64 mL (SV/BSA, 40 mL/m2); and RV ejection fraction, 24%. Phase contrast sequences in the aorta and pulmonary artery showed systemic output of 20 mL and pulmonary output of 18 mL. Tricuspid regurgitation was massive (46 mL).
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Affiliation(s)
- Settimo Caruso
- From the Department of Diagnostic and Therapeutic Services (S.C.), and Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Cardiology Unit (G.R.), Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; and Department of Radiology, Mater Dei Hospital, Msida, Malta (C.C.)
| | - Christine Cannataci
- From the Department of Diagnostic and Therapeutic Services (S.C.), and Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Cardiology Unit (G.R.), Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; and Department of Radiology, Mater Dei Hospital, Msida, Malta (C.C.)
| | - Giuseppe Romano
- From the Department of Diagnostic and Therapeutic Services (S.C.), and Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Cardiology Unit (G.R.), Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; and Department of Radiology, Mater Dei Hospital, Msida, Malta (C.C.)
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Cherian KM, W LJ, Thayub M. Overview and surgical aspects of Uhls anomaly. Expert Opin Orphan Drugs 2020. [DOI: 10.1080/21678707.2020.1709442] [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: 10/25/2022]
Affiliation(s)
- Kotturathu Mammen Cherian
- Department of Cardiothoracic Surgery, Frontier Lifeline Hospital and Dr. K. M. Cherian Heart Foundation, Chennai, India
| | - Lydia Jeris W
- Department of Clinical Laboratory and Blood Bank, Frontier Lifeline Hospital and Dr. K. M. Cherian Heart Foundation, Chennai, India
| | - Mohamed Thayub
- Department of Clinical Pharmacy, Frontier Lifeline Hospital and Dr. K. M. Cherian Heart Foundation, Chennai, India
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