Eur J Cardiothorac Surg 2008;33:737. doi:10.1016/j.ejcts.2008.01.004
Copyright © 2008, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
Images in cardio-thoracic surgery |
Biventricular noncompaction presenting with stroke
Vecih Oduncu,
Taylan Akgun,
Ayhan Erkol*,
Bülent Mutlu
Kosuyolu Heart and Research Hospital, Cardiology Department, Turkey
Received 20 September 2007;
received in revised form 29 December 2007;
accepted 1 January 2008.
* Corresponding author. Address: Ko
uyolu Kalp E
itim ve Arast
rma Hastanesi, Denizer Cd. Cevizli, 34880 Kartal, 
stanbul, Turkey. Tel.: +90 216 4594041; fax: +90 216 4596321. (Email: ayhanerkol{at}yahoo.com).
Key Words: Noncompaction • Stroke • Heart failure • Imaging • Transplantation
Transthoracic echocardiography of a 27-year-old male with a past medical history of a stroke revealed a severely dilated left ventricle and multiple prominent trabeculations in both ventricles (Fig. 1
). Cardiac MRI confirmed the diagnosis of biventricular noncompaction (Fig. 2
, Videos 1 and 2). He is still on our heart transplant list.
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Fig. 1. Transthoracic echocardiography revealed a dilated left ventricle and severe systolic dysfunction with an ejection fraction of 25%. Trabeculations were prominent in apex and mid inferoposterolateral wall of the left ventricle and in the right ventricular apicolateral wall. The intertrabecular recesses were rather evident and the blood flow into these recesses was clearly visualized by color Doppler imaging. The ratio of noncompacted subendocardial layer to compacted epicardial layer was more than two at endsystole. The echocardiographic appearance of the left ventricle was very characteristic of the left ventricular noncompaction and was meeting all diagnostic criteria suggested by Jenni et al. and Stöllberger et al. So, it was clearly differentiated from the possible diagnosis of apical hypertrophic cardiomyopathy or dilated cardiomyopathy. There was no other coexisting pathology such as hypertension or aortic stenosis that may be responsible for the increased wall thickness. As there are no clearly defined criteria for the right ventricular noncompaction, the right ventricular involvement was assessed on a qualitative basis and absence of any other pathology that may be responsible for the right ventricular hypertrabeculation supported the diagnosis of biventricular noncompaction. (a) Apical 4-chamber view demonstrating the prominent right and the left ventricular trabeculations and recesses. Arrowhead points to the large recess in the left ventricular apex. (b) Apical 3-chamber view demonstrating the comb-like trabeculations of the posterior wall. The long arrow points to the large apical recess.
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Fig. 2. Four-chamber (a, b) and 2-chamber (c, d) MRI views. Cardiac MRI clearly demonstrated the trabeculations and the deep recesses (bright areas within the myocardium) filled with blood communicating with the ventricular cavities. The trabeculations and recesses in both ventricles were so prominent that, not only the diastolic images (a, c) but also the systolic images clearly demonstrated the flow within the myocardium (b, d, and Videos 1 and 2).
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Appendix A
Supplementary data
Supplementary data associated with this article can be found, in the online version, at doi:10.1016/j.ejcts.2008.01.004.
Acknowledgments
We thank Dr Salih Güran and Sonomed Radiology Center for cardiac MRI images.
