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Case 288
Settimo Caruso1, Christine Cannataci1, Giuseppe Romano1
1From the Department of Diagnostic and Therapeutic Services (S.C.), and Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Cardiology Unit (G.R.), Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; and Department of Radiology, Mater Dei Hospital, Msida, Malta (C.C.).
This case study highlights a 46-year-old woman with a history of syncope and heart failure, ultimately diagnosed with massive tricuspid regurgitation and dilated right ventricle. Advanced imaging confirmed severe right ventricular dysfunction, leading to heart transplant evaluation.
Area of Science:
- Cardiology
- Medical Imaging
- Congenital Heart Disease
Background:
- A 46-year-old woman presented with decompensated congestive heart failure and pericardial effusion.
- She had a history of recurrent syncope since childhood, with no family history of sudden cardiac death.
- Initial evaluations revealed a dilated right ventricle without outflow tract obstruction, contraindicating implantable cardioverter-defibrillator placement.
Purpose of the Study:
- To investigate the underlying cardiac pathology in a patient with a history of syncope and progressive heart failure.
- To characterize the right ventricular anatomy and function using advanced imaging techniques.
- To evaluate the severity of tricuspid regurgitation and its contribution to heart failure.
Main Methods:
- Electrocardiography (ECG) and two-dimensional echocardiography were performed.
- Cardiac MRI with and without contrast was utilized for detailed volumetric and functional assessment.
- Non-cardiac-gated multidetector CT with contrast was used to exclude pulmonary embolism.
Main Results:
- Cardiac MRI revealed a severely dilated right ventricle (RVDV/BSA, 164 mL/m²) with significantly reduced ejection fraction (24%).
- Left ventricular function was preserved (ejection fraction, 47%).
- Massive tricuspid regurgitation (46 mL) was quantified, indicating severe valvular dysfunction.
Conclusions:
- The patient's presentation was attributed to severe right ventricular dilation and dysfunction secondary to massive tricuspid regurgitation.
- Advanced cardiac imaging, particularly MRI, was crucial in defining the complex cardiac anatomy and guiding management.
- The findings underscore the importance of comprehensive evaluation in patients with unexplained heart failure and syncope.
