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Ottaviani G, Tomasello T, Boggio F, Runza L, Gobbo AD, Buja LM. Sudden unexpected intrapartum death and left ventricular noncompaction involving the right ventricle. Cardiovasc Pathol 2024; 71:107633. [PMID: 38485103 DOI: 10.1016/j.carpath.2024.107633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/19/2024] [Accepted: 03/07/2024] [Indexed: 04/22/2024] Open
Abstract
Left ventricular noncompaction (LVNC), involving mainly the right ventricle, is a rare form of congenital heart disorder characterized by a developmental arrest in myocardial compaction, resulting in a spongy appearance of the myocardium, mainly of the right ventricle, rarely detected in fetuses. We report the case of a female fetus with a gestational age of 41+4 weeks who came to our attention for intrapartum sudden unexpected death, resulting in stillbirth. The ventricular walls, particularly the right ventricular wall, appeared thick, hypertrabeculated and spongy, leading to the diagnosis of LVNC involving mainly the right ventricle. The atrioventricular node and His bundle presented areas of fetal dispersion and resorptive degeneration; islands of conduction tissue were detected in the central fibrous body. Arcuate nucleus of the brainstem showed bilateral severe hypoplasia. The right bundle branch was hypoplastic. The final cause of death was an electrical conduction disfunction in an LVNC involving mainly the right ventricle. To the best of our knowledge, the herein described case is the first reported observation of sudden intrapartum death from LVNC involving mainly the right ventricle well documented post-mortem with cardiac conduction and brainstem studies. Our findings confirm the need of an accurate post-mortem examination including the study of the cardiac conduction system on serial section in every case of sudden unexpected fetal death, although there are no universally recognized guidelines.
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Affiliation(s)
- Giulia Ottaviani
- Anatomic Pathology, Lino Rossi Research Center, Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, 20122 Milan, Italy; Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX 77030, USA.
| | - Tobia Tomasello
- Department of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Francesca Boggio
- Department of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Letterio Runza
- Department of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Alessandro Del Gobbo
- Department of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX 77030, USA
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2
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Bilal MI, Ansari FA, Gondal MUR, Aftab M, Qureshi AM, Kassis-George H. Exploring the Unknown: Appreciating the Challenges of Non-compaction Cardiomyopathy. Cureus 2024; 16:e61142. [PMID: 38933642 PMCID: PMC11199402 DOI: 10.7759/cureus.61142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Left ventricular non-compaction cardiomyopathy (LVNC), or non-compaction cardiomyopathy (NCCM), is defined by pronounced left ventricular trabeculations and deep intertrabecular recesses connecting with the ventricular cavity. Patients with NCCM can be asymptomatic or have severe complications, including heart failure, arrhythmias, thromboembolism, and sudden cardiac death. Our case discusses a patient with shortness of breath who was found to have a newly decreased ejection fraction. The workup revealed non-ischemic cardiomyopathy and cardiac MRI showed hyper-trabeculations consistent with NCCM. The patient was started on oral anticoagulation and guideline-directed medical therapy (GDMT) and discharged with an event monitor. NCCM stands as a relatively rare and enigmatic condition, often veiled in ambiguity. The absence of standardized diagnostic and management protocols further complicates its clinical landscape. While echocardiography is the primary diagnostic tool, its tendency for under-diagnosis poses a significant challenge. Conversely, advanced imaging modalities like cardiac MRI may lead to instances of overdiagnosis. Treatment approaches are non-specific, incorporating GDMT, anticoagulation, implantable cardioverter-defibrillator placement, and genetic testing paired with counseling. Prioritizing genetic research is crucial to uncover tailored therapeutic interventions. Establishing consensus guidelines and refining diagnostic accuracy are pivotal steps toward mitigating the risks associated with under and over-diagnosis.
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Affiliation(s)
| | - Fawwad A Ansari
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
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Bustea C, Bungau AF, Tit DM, Iovanovici DC, Toma MM, Bungau SG, Radu AF, Behl T, Cote A, Babes EE. The Rare Condition of Left Ventricular Non-Compaction and Reverse Remodeling. Life (Basel) 2023; 13:1318. [PMID: 37374101 PMCID: PMC10305066 DOI: 10.3390/life13061318] [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: 04/30/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Left ventricular non-compaction (LVNC) is a rare disease defined by morphological criteria, consisting of a two-layered ventricular wall, a thin compacted epicardial layer, and a thick hyper-trabeculated myocardium layer with deep recesses. Controversies still exist regarding whether it is a distinct cardiomyopathy (CM) or a morphological trait of different conditions. This review analyzes data from the literature regarding diagnosis, treatment, and prognosis in LVNC and the current knowledge regarding reverse remodeling in this form of CM. Furthermore, for clear exemplification, we report a case of a 41-year-old male who presented symptoms of heart failure (HF). LVNC CM was suspected at the time of transthoracic echocardiography and was subsequently confirmed upon cardiac magnetic resonance imaging. A favorable remodeling and clinical outcome were registered after including an angiotensin receptor neprilysin inhibitor in the HF treatment. LVNC remains a heterogenous CM, and although a favorable outcome is not commonly encountered, some patients respond well to therapy.
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Affiliation(s)
- Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Alexa Florina Bungau
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Delia Mirela Tit
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Diana Carina Iovanovici
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Mirela Marioara Toma
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
| | - Andrei-Flavius Radu
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (D.C.I.); (M.M.T.); (S.G.B.); (A.-F.R.)
| | - Tapan Behl
- School of Health Sciences & Technology, University of Petroleum and Energy Studies, Bidholi, Dehradun 248007, India;
| | - Adrian Cote
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Elena Emilia Babes
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
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Sarohi V, Srivastava S, Basak T. A Comprehensive Outlook on Dilated Cardiomyopathy (DCM): State-Of-The-Art Developments with Special Emphasis on OMICS-Based Approaches. J Cardiovasc Dev Dis 2022; 9:jcdd9060174. [PMID: 35735803 PMCID: PMC9225617 DOI: 10.3390/jcdd9060174] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023] Open
Abstract
Dilated cardiomyopathy (DCM) remains an enigmatic cardiovascular disease (CVD) condition characterized by contractile dysfunction of the myocardium due to dilation of the ventricles. DCM is one of the major forms of CVD contributing to heart failure. Dilation of the left or both ventricles with systolic dysfunction, not explained by known causes, is a hallmark of DCM. Progression of DCM leads to heart failure. Genetic and various other factors greatly contribute to the development of DCM, but the etiology has still remained elusive in a large number of cases. A significant number of studies have been carried out to identify the genetic causes of DCM. These candidate-gene studies revealed that mutations in the genes of the fibrous, cytoskeletal, and sarcomeric proteins of cardiomyocytes result in the development of DCM. However, a significant proportion of DCM patients are idiopathic in nature. In this review, we holistically described the symptoms, causes (in adults and newborns), genetic basis, and mechanistic progression of DCM. Further, we also summarized the state-of-the-art diagnosis, available biomarkers, treatments, and ongoing clinical trials of potential drug regimens. DCM-mediated heart failure is on the rise worldwide including in India. The discovery of biomarkers with a better prognostic value is the need of the hour for better management of DCM-mediated heart failure patients. With the advent of next-generation omics-based technologies, it is now possible to probe systems-level alterations in DCM patients pertaining to the identification of novel proteomic and lipidomic biomarkers. Here, we also highlight the onset of a systems-level study in Indian DCM patients by applying state-of-the-art mass-spectrometry-based “clinical proteomics” and “clinical lipidomics”.
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Affiliation(s)
- Vivek Sarohi
- Indian Institute of Technology (IIT)-Mandi, School of Basic Sciences (SBS), Mandi 175075, HP, India; (V.S.); (S.S.)
- BioX Centre, Indian Institute of Technology (IIT)-Mandi, Mandi 175075, HP, India
| | - Shriya Srivastava
- Indian Institute of Technology (IIT)-Mandi, School of Basic Sciences (SBS), Mandi 175075, HP, India; (V.S.); (S.S.)
| | - Trayambak Basak
- Indian Institute of Technology (IIT)-Mandi, School of Basic Sciences (SBS), Mandi 175075, HP, India; (V.S.); (S.S.)
- BioX Centre, Indian Institute of Technology (IIT)-Mandi, Mandi 175075, HP, India
- Correspondence: ; Tel.: +91-1905-267826
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Lorca R, Martín M, Pascual I, Astudillo A, Díaz Molina B, Cigarrán H, Cuesta-Llavona E, Avanzas P, Rodríguez Reguero JJ, Coto E, Morís C, Gómez J. Characterization of Left Ventricular Non-Compaction Cardiomyopathy. J Clin Med 2020; 9:jcm9082524. [PMID: 32764337 PMCID: PMC7464545 DOI: 10.3390/jcm9082524] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 01/06/2023] Open
Abstract
Left ventricle non-compaction cardiomyopathy (LVNC) has gained great interest in recent years, being one of the most controversial cardiomyopathies. There are several open debates, not only about its genetic heterogeneity, or about the possibility to be an acquired cardiomyopathy, but also about its possible overdiagnosis based on imaging techniques. In order to better understand this entity, we identified 38 LVNC patients diagnosed by cardiac MRI (CMRI) or anatomopathological study that could underwent NGS-sequencing and clinical study. Anatomopathological exam was performed in eight available LVNC hearts. The genetic yield was 34.2%. Patients with negative genetic testing had better left ventricular ejection fraction (LVEF) or it showed a tendency to improve in follow-up, and a possible trigger factor for LVNC was identified in 1/3 of them. Nonetheless, cerebrovascular accidents occurred in similar proportions in both groups. We conclude that in LVNC there seem to be different ways to achieve the same final phenotype. Genetic testing has a good genetic yield and provides valuable information. LVNC without an underlying genetic cause may have a better prognosis in terms of LVEF evolution. However, anticoagulation to prevent cerebrovascular accident (CVA) should be carefully evaluated in all patients. Larger series with pathologic examination are needed to help better understand this entity.
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Affiliation(s)
- Rebeca Lorca
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - María Martín
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Isaac Pascual
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
- Faculty of Medicine, University of Oviedo, 33014 Oviedo, Spain;
- Correspondence: ; Tel.: +34-985-108-000; Fax: +34-985-274-688
| | - Aurora Astudillo
- Faculty of Medicine, University of Oviedo, 33014 Oviedo, Spain;
- Anatomía Patológica, Hospital Universitario Central Asturias, 33014 Oviedo, Spain
| | - Beatriz Díaz Molina
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Helena Cigarrán
- Servicio de Radiodiagnóstico, Hospital Universitario Central Asturias, 33014 Oviedo, Spain;
| | - Elías Cuesta-Llavona
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Pablo Avanzas
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
- Faculty of Medicine, University of Oviedo, 33014 Oviedo, Spain;
| | - José Julían Rodríguez Reguero
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
| | - Eliecer Coto
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
- Faculty of Medicine, University of Oviedo, 33014 Oviedo, Spain;
| | - César Morís
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
- Faculty of Medicine, University of Oviedo, 33014 Oviedo, Spain;
| | - Juan Gómez
- Unidad de Referencia de Cardiopatías Familiares-HUCA, Área del Corazón y Departamento de Genética Molecular, Hospital Universitario Central Asturias, 33014 Oviedo, Spain; (R.L.); (M.M.); (B.D.M.); (E.C.-L.); (P.A.); (J.J.R.R.); (E.C.); (C.M.); (J.G.)
- Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, 33014 Oviedo, Spain
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Streltsova AA, Gudkova AY, Kostareva AA. [Left ventricular non - compaction: contemporary view of genetic background, clinical course, diagnostic and treatment]. TERAPEVT ARKH 2019; 91:90-97. [PMID: 32598595 DOI: 10.26442/00403660.2019.12.000142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 01/10/2023]
Abstract
This review highlights and discusses recent advances in understanding left ventricular non - compaction (LVNC). Clinical profile, prognosis and even diagnosis are still a great challenge faced by the world. The population prevalence of left ventricular non - compaction remains unknown. High variability of clinical manifestations, genetic heterogenity with overlap of different phenotypes, variability of hereditary patterns suggests that LVNC seems to be rather an isolated trait or a part of phenotypic expression of different cardiac diseases or complex genetic syndromes.
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Affiliation(s)
| | - A Y Gudkova
- Almazov Federal Medical Research Centre.,Pavlov First St. Petersburg State Medical University
| | - A A Kostareva
- Almazov Federal Medical Research Centre.,Pavlov First St. Petersburg State Medical University
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García Pérez JL, Jiménez Almonacid J, Palomino Doza AJ, Delgado Jiménez JF, Enguita Valls AB. ["Staghorn" heart. The pathology of the explanted heart of a patient with clinical diagnosis and genetic variants of non-compacted myocardiopathy]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 54:127-131. [PMID: 33726889 DOI: 10.1016/j.patol.2019.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/02/2019] [Accepted: 01/16/2019] [Indexed: 01/10/2023]
Abstract
Non-compacted myocardiopathy is rare, the prevalence ranging between 0.01-0.26%. in adults. We present the macroscopic, microscopic and electron microscopy findings of cardiac transplant samples from a 36-year-old patient diagnosed with non-compacted myocardiopathy. This condition shows a high genetic and phenotypic heterogeneity, with superposition of different phenotypes and variability in the hereditary patterns. Clinical diagnosis is established by coupling imaging results to clinical characteristics. The clinical manifestations of non-compacted myocardiopathy are variable, including arrhythmic events and variable degrees of cardiac failure, although some patients may be asymptomatic. In certain cases a heart transplant may be necessary. The differential diagnosis should be made with hypertrophic and dilated myocardiopathy. However, only a few reports can be found in the literature that discuss the pathology of this condition.
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8
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Noncompaction cardiomyopathy in Hirschsprung's disease: a case report. Cardiovasc Pathol 2017; 27:51-53. [PMID: 28131074 DOI: 10.1016/j.carpath.2016.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/11/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022] Open
Abstract
Noncompaction cardiomyopathy is a rare disorder, often associated with cardiac and noncardiac malformations. Hirschsprung's disease, a well-known aganglionosis, is associated with congenital heart diseases and has been reported to be due to impairment migration and differentiation of neural crest cells. Here, we present an 8-month-old male infant who died for cardiogenic shock after surgical resection of the involved bowel segment. The child was affected by both noncompaction cardiomyopathy and Hirschsprung's disease, two entities which can share a common neural crest-derived etiology.
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9
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Jensen B, Agger P, de Boer BA, Oostra RJ, Pedersen M, van der Wal AC, Nils Planken R, Moorman AFM. The hypertrabeculated (noncompacted) left ventricle is different from the ventricle of embryos and ectothermic vertebrates. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2015; 1863:1696-706. [PMID: 26516055 DOI: 10.1016/j.bbamcr.2015.10.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 12/11/2022]
Abstract
Ventricular hypertrabeculation (noncompaction) is a poorly characterized condition associated with heart failure. The condition is widely assumed to be the retention of the trabeculated ventricular design of the embryo and ectothermic (cold-blooded) vertebrates. This assumption appears simplistic and counterfactual. Here, we measured a set of anatomical parameters in hypertrabeculation in man and in the ventricles of embryos and animals. We compared humans with left ventricular hypertrabeculation (N=21) with humans with structurally normal left ventricles (N=54). We measured ejection fraction and ventricular trabeculation using cardiovascular MRI. Ventricular trabeculation was further measured in series of embryonic human and 9 animal species, and in hearts of 15 adult animal species using MRI, CT, or histology. In human, hypertrabeculated left ventricles were significantly different from structurally normal left ventricles by all structural measures and ejection fraction. They were far less trabeculated than human embryonic hearts (15-40% trabeculated volume versus 55-80%). Early in development all vertebrate embryos acquired a ventricle with approximately 80% trabeculations, but only ectotherms retained the 80% trabeculation throughout development. Endothermic (warm-blooded) animals including human slowly matured in fetal and postnatal stages towards ventricles with little trabeculations, generally less than 30%. Further, the trabeculations of all embryos and adult ectotherms were very thin, less than 50 μm wide, whereas the trabeculations in adult endotherms and in the setting of hypertrabeculation were wider by orders of magnitude. It is concluded in contrast to a prevailing assumption, the hypertrabeculated left ventricle is not like the ventricle of the embryo or of adult ectotherms. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.
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Affiliation(s)
- Bjarke Jensen
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Peter Agger
- Department of Clinical Medicine, Aarhus University Hospital, Denmark
| | - Bouke A de Boer
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Roelof-Jan Oostra
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Michael Pedersen
- MR Research Center, Department of Clinical Medicine, Aarhus University, Denmark
| | - Allard C van der Wal
- Department of Pathology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - R Nils Planken
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Antoon F M Moorman
- Department of Anatomy, Embryology & Physiology, Academic Medical Center, University of Amsterdam, The Netherlands
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