Occurrence of Multiple Fibrofatty Replacements Exclusively in the Left Ventricle of a Patient With Monomorphic Sustained Ventricular Tachycardia
2007; Lippincott Williams & Wilkins; Volume: 115; Issue: 25 Linguagem: Inglês
10.1161/circulationaha.106.677062
ISSN1524-4539
AutoresKoki Nakamura, Nobusada Funabashi, Hideyuki Miyauchi, Mari Aminaka, Masae Uehara, Marehiko Ueda, Takashi Nakayama, Nakabumi Kuroda, Yoshio Kobayashi, Hiroyuki Takano, Issei Komuro,
Tópico(s)Cardiac pacing and defibrillation studies
ResumoHomeCirculationVol. 115, No. 25Occurrence of Multiple Fibrofatty Replacements Exclusively in the Left Ventricle of a Patient With Monomorphic Sustained Ventricular Tachycardia Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBOccurrence of Multiple Fibrofatty Replacements Exclusively in the Left Ventricle of a Patient With Monomorphic Sustained Ventricular Tachycardia Koki Nakamura, MD, Nobusada Funabashi, MD, Hideyuki Miyauchi, MD, Mari Aminaka, MD, Masae Uehara, MD, Marehiko Ueda, MD, Takashi Nakayama, MD, Nakabumi Kuroda, MD, Yoshio Kobayashi, MD, Hiroyuki Takano, MD and Issei Komuro, MD Koki NakamuraKoki Nakamura From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Nobusada FunabashiNobusada Funabashi From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Hideyuki MiyauchiHideyuki Miyauchi From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Mari AminakaMari Aminaka From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Masae UeharaMasae Uehara From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Marehiko UedaMarehiko Ueda From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Takashi NakayamaTakashi Nakayama From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Nakabumi KurodaNakabumi Kuroda From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Yoshio KobayashiYoshio Kobayashi From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. , Hiroyuki TakanoHiroyuki Takano From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. and Issei KomuroIssei Komuro From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. Originally published26 Jun 2007https://doi.org/10.1161/CIRCULATIONAHA.106.677062Circulation. 2007;115:e640–e642A 34-year-old man presented with cardiovascular syncope with sustained ventricular tachycardia (VT). ECG showed VT with morphologically right bundle-branch block with a-superior-axis. Cardioversion and endotracheal intubation were performed. After resolution of VT, a 12-lead ECG showed sinus rhythm, normal axis deviation, and isolated premature ventricular contraction of right bundle-branch block morphology with a-superior-axis. The transthoracic echocardiogram showed regional abnormality of contraction in the posterior area of the left ventricle with no abnormality of the right ventricle. Obstructive coronary heart disease was excluded by angiography but left ventriculography demonstrated regional contraction abnormality in the anterolateral left ventricle. Electrophysiologically, nonsustained VT induced by programmed ventricular stimulation had similar morphology as the wide QRS tachycardia on admission, but sustained VT was not reproducibly induced. Furthermore, supraventricular tachycardia with aberrant conduction was absent, which suggests that the wide QRS tachycardia could be VT. ECG-gated multislice computed tomography (Figure 1) revealed focal low-density areas (mean, ≈−80 HU) indicative of fatty infiltration in the septum and the epicardium in the posterior and lateral wall of the left ventricle; however, fat infiltration was absent in the right ventricle myocardium. Compared with the low-density area in the posterior wall, part of the low-density area in the interventricular septum was abnormally enhanced (arrowhead, Figure 1B) in the late phase, which suggests the presence of fibrosis around fat infiltration. Download figureDownload PowerPointFigure 1. Axial source (A and B) and multiplanar reconstruction images of long axis (C) and short axis (D) of the left ventricle of enhanced ECG-gated multislice computed tomography revealed focal low-density areas (mean, ≈−80 HU) indicative of fatty infiltration in the interventricular septum and along the epicardium in the posterior and lateral walls of the left ventricle. A, C, and D were acquired in the early phase, and B was acquired in the late phase; A and B were axial source images of the same level. Compared with the low-density area in the posterior wall, part of the low-density area in the interventricular septum was abnormally enhanced (▿), which suggests presence of fibrosis around fat infiltration.Biopsy of left ventricular posterior wall revealed fibrofatty replacements (arrows, Figure 2); right ventricle biopsy was not performed. QRS waveform suggested VT was likely caused by arrhythmia that resulted from ventricular dysplasia. A cardioverter defibrillator was implanted and its proper discharge for sustained VT was confirmed. Download figureDownload PowerPointFigure 2. Microscopic examination of myocardial biopsy specimen obtained from the posterior wall of the left ventricle on day 20 of hospitalization demonstrated fibrofatty replacement. Arrows indicate hematoxylin-eosin stain. Magnification in A, ×100; in B, ×200.DisclosuresNone.FootnotesCorrespondence to Issei Komuro, MD, Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ozawa K, Funabashi N, Takaoka H, Tanabe N, Tatsumi K and Kobayashi Y (2017) Detection of right ventricular myocardial fibrosis using quantitative CT attenuation of the right ventricular myocardium in the late phase on 320 slice CT in subjects with pulmonary hypertension, International Journal of Cardiology, 10.1016/j.ijcard.2016.11.131, 228, (165-168), Online publication date: 1-Feb-2017. 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. 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. 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. 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. 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. 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. June 26, 2007Vol 115, Issue 25 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.677062PMID: 17592083 Originally publishedJune 26, 2007 PDF download Advertisement SubjectsComputerized Tomography (CT)
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