The case of the diagnosis and treatment of a rare form of cardiomyopathy – isolated noncompaction of the left ventricular myocardium

Authors: R.A. Shomakhov, E.Z. Golukhova, T.V. Mashina, V.N. Makarenko.

Company: A.N. Bakoulev Scientific Center for Cardiovascular Surgery of Russian Academy of Medical Sciences


For citation: Shomakhov R.A., Golukhova EZ, Mashina TV, at al. The case of the diagnosis and treatment of a rare form of cardiomyopathy — isolated noncompaction of the left ventricular myocardium. Kreativnaya kardiologiya. 2013; 2: 78-84 (in Russian).

Keywords: isolated noncompaction of the left ventricular myocardium cardiomyopathy, ventricular tachycardia, cardioverter-defibrillator, non coronary-associated ventricular arrhythmias

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Abstract

Introduction. Noncompaction cardiomyopathy (NCM) – a rare form of cardiomyopathy, which is characterized by abnormal left ventricular hypertrabeculation with the formation of two layers of the myocardium – normal and non-compact as a result of intrauterine arrest of compaction of the myocardial fibers. In this case report, the typical echocardiographic images, and MRI results of a case with noncompaction cardiomyopathy.

Case report. A 56-year-old female was referred to our institution because of frequent and sustained episodes of palpitations associated with dyspnea and dizziness. About 5 years ago on the ECG detected frequent ventricular premature beats. Hemodynamically significant coronary stenoses were not identified. After an episode of sustained ventricular tachycardia with syncope, documented by ECG, patient was admitted Bakoulev center to conduct electrophysiological study and radiofrequency ablation of arrhythmogenic zones. An electrocardiography (ECG) demonstrated frequent ventricular premature beats (VPC). Holter monitoring shows frequent monomorphic VPC (more than 7,000) and nonsustained ventricular tachycardia. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed features of LV: prominent trabecularization of the apex and the posterolateral wall; deep intertrabecular recesses with flow coming out fr om ventricular cavity; the end-systolic thickness ratio between noncompacted and compacted myocardium was more than 2.5. Cardiac MRI with LGE confirmed the diagnosis. At electrophysiological study induced paroxysm of nonsustained polymorphic ventricular tachycardia. Given the clinical history and the results of the examination, for the prevention of sudden cardiac death a single-chamber cardioverter-defibrillator was implanted. During hospitalization cardioverterdefibrillator shock was not fixed. The patient was discharged on the eighth day.

Discussion. In this case report ventricular arrhythmias were the single clinical manifestation of the disease. Although ICD is an effective option for preventing SCD, data on the long-term follow-up of patients with LVNC is lim ited.

Conclusions. Modern instrumental methods have high sensitivity and specificity in the diagnosis of rare forms of cardiomyopathy and particular non-compaction of the left ventricular myocardium. Verification of the diagnosis allows to choose the correct surgical treatment.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery