Right ventricle-dominant cardiac sarcoidosis with sparing of the left ventricle

Cardiac sarcoidosis is a common and often fatal complication of systemic sarcoidosis. When present, cardiac sarcoid is generally a diffuse and patchy process involving predominantly the left ventricle. We report the case of a patient with known cardiac sarcoidosis who underwent cardiac transplantation for poorly controlled ventricular tachycardia and heart failure. His explanted heart had a previously undescribed distribution of sarcoidosis. This patient had complete, circumferential involvement of the right ventricle with near-total loss of right ventricular wall myocardium, and secondary marked dilation. The interventricular septum was predominantly involved along the right ventricle. The cardiac conducting system was also extensively involved, showing granulomatous disease. The left ventricular free wall was spared of any gross evidence of sarcoidosis. We present the unusual pathologic findings of the explanted heart and correlate the results with the patient's clinical data.