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Right-Sided Heart Wall Thickening and Delayed Enhancement Caused by Chronic Active Myocarditis Complicated by Sustained Monomorphic Ventricular Tachycardia

2009; Lippincott Williams & Wilkins; Volume: 119; Issue: 6 Linguagem: Inglês

10.1161/circulationaha.108.788380

1524-4539

Yoshiyuki Hama, Nobusada Funabashi, Marehiko Ueda, Tomonori Kanaeda, Masae Uehara, Koki Nakamura, Taichi Murayama, Yoko Mikami, Hiroyuki Takaoka, Miyuki Kawakubo, Kwang Ho Lee, Hiroyuki Takano, Issei Komuro,

Cardiomyopathy and Myosin Studies

HomeCirculationVol. 119, No. 6Right-Sided Heart Wall Thickening and Delayed Enhancement Caused by Chronic Active Myocarditis Complicated by Sustained Monomorphic Ventricular Tachycardia Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBRight-Sided Heart Wall Thickening and Delayed Enhancement Caused by Chronic Active Myocarditis Complicated by Sustained Monomorphic Ventricular Tachycardia Yoshiyuki Hama, MD, Nobusada Funabashi, MD, Marehiko Ueda, MD, Tomonori Kanaeda, MD, Masae Uehara, MD, Koki Nakamura, MD, Taichi Murayama, MD, Yoko Mikami, MD, Hiroyuki Takaoka, MD, Miyuki Kawakubo, MD, Kwangho Lee, MD, Hiroyuki Takano, MD and Issei Komuro, MD Yoshiyuki HamaYoshiyuki Hama From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Nobusada FunabashiNobusada Funabashi From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Marehiko UedaMarehiko Ueda From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Tomonori KanaedaTomonori Kanaeda From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Masae UeharaMasae Uehara From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Koki NakamuraKoki Nakamura From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Taichi MurayamaTaichi Murayama From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Yoko MikamiYoko Mikami From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Hiroyuki TakaokaHiroyuki Takaoka From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Miyuki KawakuboMiyuki Kawakubo From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Kwangho LeeKwangho Lee From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. , Hiroyuki TakanoHiroyuki Takano From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. and Issei KomuroIssei Komuro From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Originally published17 Feb 2009https://doi.org/10.1161/CIRCULATIONAHA.108.788380Circulation. 2009;119:e200–e203is corrected byCorrectionAn asymptomatic healthy 65-year-old man was referred to a hospital for inverted T waves in the precordial leads (Figure 1) with paroxysmal advanced atrioventricular block in the ECG. Chest x-ray showed mild cardiac enlargement (Figure 2), and an echocardiogram showed right ventricular (RV) wall thickening (arrow in Figure 3). Five months later, the patient was referred to another hospital complaining of chest discomfort. Coronary angiogram was normal, but sustained monomorphic ventricular tachycardia (VT) occurred. Suffering from incessant VT, the patient was transferred to our hospital. The ECG and echocardiogram were almost the same as in previous studies. Enhanced multislice computed tomography revealed isolated right atrial, RV, and partial left ventricular (LV) wall thickening with extensive delayed enhancement (Figure 4) but no other organic diseases, which was confirmed by cardiac magnetic resonance (Figure 5). Download figureDownload PowerPointFigure 1. ECG acquired when the subject was referred to hospital showed inverted T waves in the precordial leads.Download figureDownload PowerPointFigure 2. Chest x-ray showed mild cardiac enlargement.Download figureDownload PowerPointFigure 3. Transthoracic echocardiogram showed pericardial effusion and RV wall thickening (arrow) with no LV hypertrophy and normal systolic function of both ventricles.Download figureDownload PowerPointFigure 4. Axial source (A and B) and multiplanar reconstruction images (C) of enhanced multislice computed tomography revealed thickening of the right atrial (RA) and RV free walls (arrows in A and C) and part of the LV wall, which were abnormally enhanced in the later phase, as well as part of LV (arrows in B), suggesting lymphocytic infiltration and edema. AAo indicates ascending aorta.Download figureDownload PowerPointFigure 5. Cardiac magnetic resonance image revealed delayed enhancement (arrows) in the RV and part of the LV that was also observed in multislice computed tomography.In an electrophysiological study, 2 sustained monomorphic VTs (Figure 6) were induced, located in the RV midseptum by endocardial ventricular mapping. Radiofrequency ablation was performed at both sites; subsequently, neither VT could be induced. Because of the multislice computed tomography and cardiac magnetic resonance findings, endocardial biopsies were obtained from the RV (Figure 7) that showed interstitial edema, fibrosis, and myocyte destruction with a dense infiltrate of lymphocytes, suggesting chronic active myocarditis, which was consistent with his clinical course. Presumably, the thickening of the right atrial and RV free walls is related to lymphocytic infiltration and edema in the multislice computed tomography and cardiac magnetic resonance. A cardioverter-defibrillator was implanted, and the patient was given 40 mg/d prednisolone. He had no recurrent VTs after discharge. Download figureDownload PowerPointFigure 6. In an electrophysiological study, 2 clinical sustained monomorphic VTs were induced.Download figureDownload PowerPointFigure 7. Histological results of endomyocardial biopsies. A, Hematoxylin and eosin staining demonstrated active myocarditis with focal lymphocytic infiltration with adjacent myocytolysis (×100). B, Immunohistological staining of T cells with focal infiltration pattern (×100).DisclosuresNone.FootnotesCorrespondence to Issei Komuro, MD, PhD, Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Inohana 1–8–1, Chuo-ku, Chiba City, Chiba 260–8670, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zhan Y and Shah D (2021) Assessment of the tricuspid valve using cardiovascular magnetic resonance, Current Opinion in Cardiology, 10.1097/HCO.0000000000000887, 36:5, (505-512), Online publication date: 1-Sep-2021. Sato T, Iwahana T, Ito R, Kondo Y and Kobayashi Y (2021) Right ventricular dominant myocarditis requiring cardiac resynchronization therapy‐defibrillator: a case report, ESC Heart Failure, 10.1002/ehf2.13658, 8:6, (5572-5576), Online publication date: 1-Dec-2021. Takaoka H, Uehara M, Saito Y, Ota J, Iida Y, Takahashi M, Sano K, Komuro I and Kobayashi Y (2020) Improved Diagnostic Performance of New-generation 320-slice Computed Tomography with Forward-projected Model-based Iterative Reconstruction SoluTion for the Assessment of Late Enhancement in Left Ventricular Myocardium, Internal Medicine, 10.2169/internalmedicine.4561-20, 59:17, (2095-2103), Online publication date: 1-Sep-2020. Khalique O, Cavalcante J, Shah D, Guta A, Zhan Y, Piazza N and Muraru D (2019) Multimodality Imaging of the Tricuspid Valve and Right Heart Anatomy, JACC: Cardiovascular Imaging, 10.1016/j.jcmg.2019.01.006, 12:3, (516-531), Online publication date: 1-Mar-2019. Takaoka H, Funabashi N, Ozawa K, Uehara M, Sano K, Komuro I and Kobayashi Y (2018) Improved Diagnosis of Detection of Late Enhancement in Left Ventricular Myocardium Using 2nd Generation 320-Slice CT Reconstructed with FIRST in Non-Ischemic Cardiomyopathy, International Heart Journal, 10.1536/ihj.17-210, 59:3, (542-549), Online publication date: 31-May-2018. Numano F, Shimizu C, Tremoulet A, Dyar D, Burns J and Printz B (2015) Pulmonary Artery Dilation and Right Ventricular Function in Acute Kawasaki Disease, Pediatric Cardiology, 10.1007/s00246-015-1303-5, 37:3, (482-490), Online publication date: 1-Mar-2016. Ono R, Funabashi N, Takaoka H, Ozawa K, Ota S, Nakatani Y, Matsumiya G and Kobayashi Y (2016) Massive myocardial aneurysm due to inferior to posterior myocardial infarction complicated with right-sided heart failure in a 36-year-old male, International Journal of Cardiology, 10.1016/j.ijcard.2016.01.076, 209, (98-102), Online publication date: 1-Apr-2016. Nishimura K, Funabashi N, Takahashi Y, Hasegawa H, Takaoka H, Fujimoto Y, Kitagawa M, Nakatani Y and Kobayashi Y (2016) Cardiac Fabry disease with plural mass fibrosis observed in the thickened left ventricular wall, International Journal of Cardiology, 10.1016/j.ijcard.2015.09.045, 202, (552-555), Online publication date: 1-Jan-2016. Biase L, Santangeli P, Burkhardt J, Shivkumar K and Natale A (2014) Special Ablation Approaches Cardiac Electrophysiology: From Cell to Bedside, 10.1016/B978-1-4557-2856-5.00125-4, (1263-1276), . Ozawa K, Funabashi N, Kataoka A, Tanabe N, Yanagawa N, Tatsumi K and Kobayashi Y (2013) Myocardial fibrosis in the right ventricle detected on ECG gated 320 slice CT showed a short term poor prognosis in subjects with pulmonary hypertension, International Journal of Cardiology, 10.1016/j.ijcard.2013.01.251, 168:1, (584-586), Online publication date: 1-Sep-2013. Russo A, Casella M, Pieroni M, Pelargonio G, Bartoletti S, Santangeli P, Zucchetti M, Innocenti E, Di Biase L, Carbucicchio C, Bellocci F, Fiorentini C, Natale A and Tondo C (2012) Drug-Refractory Ventricular Tachycardias After Myocarditis, Circulation: Arrhythmia and Electrophysiology, 5:3, (492-498), Online publication date: 1-Jun-2012. Yajima R, Kataoka A, Takahashi A, Uehara M, Saito M, Yamaguchi C, Lee K, Komuro I and Funabashi N (2012) Distinguishing focal fibrotic lesions and non-fibrotic lesions in hypertrophic cardiomyopathy by assessment of regional myocardial strain using two-dimensional speckle tracking echocardiography: Comparison with multislice CT, International Journal of Cardiology, 10.1016/j.ijcard.2011.01.096, 158:3, (423-432), Online publication date: 1-Jul-2012. Nomura S, Funabashi N, Tsubura M, Uehara M, Shiina Y, Daimon M, Tateno K, Nagai T and Komuro I (2011) Cardiac sarcoidosis evaluated by multimodality imaging, International Journal of Cardiology, 10.1016/j.ijcard.2009.11.027, 150:2, (e81-e84), Online publication date: 1-Jul-2011. Kataoka A, Funabashi N, Takahashi A, Yajima R, Takahashi M, Uehara M, Takaoka H, Saito M, Yamaguchi C, Lee K, Nomura F and Komuro I (2011) Quantitative evaluation of left atrial volumes and ejection fraction by 320-slice computed-tomography in comparison with three- and two-dimensional echocardiography: A single-center retrospective-study in 22 subjects, International Journal of Cardiology, 10.1016/j.ijcard.2010.08.036, 153:1, (47-54), Online publication date: 1-Nov-2011. Uehara M, Funabashi N, Miyagi J, Suzuki M, Sekine T, Takaoka H, Takahashi K and Komuro I (2011) Comparison of three techniques for evaluation of de novo asymptomatic pulmonary arterial thrombosis following deep vein thrombosis in total knee arthroplasty, International Journal of Cardiology, 10.1016/j.ijcard.2009.09.556, 148:1, (11-16), Online publication date: 1-Apr-2011. Ono H, Funabashi N, Uehara M, Yajima R, Kataoka A, Ueda M, Miyauchi H, Daimon M, Takaoka H and Komuro I (2010) Comprehensive evaluation of characteristics of left ventricular myocardium in a subject with non-coronary arterial cardiac dysfunction through segment by segment analysis using various diagnostic modalities, International Journal of Cardiology, 10.1016/j.ijcard.2009.05.055, 145:1, (95-100), Online publication date: 1-Nov-2010. Yoshida N, Funabashi N, Uehara M, Yajima R, Kataoka A, Ueda M, Takaoka H and Komuro I (2010) Differentiation of diagnosis and prognoses of non-coronary arterial primary myocardial diseases with left ventricular focal myocardial thinning evaluated by multislice computed tomography, International Journal of Cardiology, 10.1016/j.ijcard.2009.09.554, 145:2, (277-281), Online publication date: 1-Nov-2010. Related articlesCorrectionCirculation. 2009;119:e378-e378 February 17, 2009Vol 119, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.788380PMID: 19221224 Originally publishedFebruary 17, 2009 PDF download Advertisement SubjectsComputerized Tomography (CT)