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[Left ventricular aneurysm in a patient with mildly dilated cardiomyopathy]
L De Biase1, A Berni, G P Giorda
1II Cattedra di Cardiologia, Università degli Studi La Sapienza, Roma. debiase@uniromal.it
Insights
This case report details a patient with idiopathic cardiomyopathy and left ventricular aneurysm, unassociated with coronary artery disease. The findings highlight a rare association, emphasizing the need for comprehensive diagnostics in unexplained cardiac conditions.
Area of Science:
- Cardiology
- Pulmonology
- Genetics
Background:
- Idiopathic cardiomyopathy (ICM) is a diverse group of myocardial diseases.
- Left ventricular aneurysm (LVA) is typically associated with myocardial infarction (MI).
- The co-occurrence of ICM, LVA, and absence of coronary artery disease is exceptionally rare.
Observation:
- A patient presented with ICM and LVA without prior MI history.
- Cardiac catheterization revealed no coronary stenosis but slow contrast runoff.
- Endomyocardial biopsy showed hypertrophic myocytes and interstitial fibrosis.
- Pulmonary imaging identified emphysema, interstitial thickening, and bronchiectasis.
- Reduced alpha-1-anti-trypsin plasma levels were noted.
Findings:
- The case presents the second report of LVA in ICM without coronary artery disease.
- Associated pulmonary findings suggest a potential underlying genetic or systemic condition.
- Histopathological findings in the heart support a non-ischemic cardiomyopathy.
Implications:
- This case underscores the importance of considering non-ischemic etiologies for LVA.
- The association with pulmonary findings and reduced alpha-1-anti-trypsin warrants further investigation into genetic factors.
- Combined heart-lung transplantation was necessary due to clinical deterioration.
Abstract:
We describe the case of a patient with mildly dilated idiopathic cardiomyopathy and left ventricular aneurysm, diagnosed in absence of a prior clinical history and anatomo-pathological features of myocardial infarction. To ascertain the diagnosis of idiopathic cardiomyopathy, the patient underwent cardiac catheterization with coronary angiography, that showed the lack of epicardial artery stenosis and a slow run-off of the contrast. An endomyocardial biopsy showed the presence of hypertrophic myocytes and interstitial fibrosis. Moreover, a thoracic high resolution computed tomography showed the features of pulmonary bilateral basal emphysema, interstitial thickening and bronchiectasis. Alfa1-anti-trypsin plasma levels were reduced. The patient, because of worsening of clinical and hemodynamic conditions, underwent at age of 36 a combined heart-lung transplantation. The pathological examination of the native organs confirmed the previous diagnosis. At the moment, this is the second report in the literature concerning the presence of left ventricular aneurysm in a patient with idiopathic cardiomyopathy without an underlying coronary artery disease or prior history of myocardial infarction.