J Korean Soc Radiol.  2010 Nov;63(5):419-423. 10.3348/jksr.2010.63.5.419.

Cardiac MRI and Transthoracic Echocardiography of Left Ventricular Myocardial Noncompaction in A Patient with Congestive Heart Failure: A Case Report

• Cho EM
• Byun JN
• Kim DH

• KMID: 2097911
• DOI: http://doi.org/10.3348/jksr.2010.63.5.419

Abstract

We report a case of a 38-year-old male presenting with new-onset dyspnea, that was diagnosed as left ventricular noncompaction by transthoracic echocardiographic and cardiac MR. The tests revealed left ventricularsystolic dysfunction with prominent trabeculations associated with deep intertrabecular recesses and an end-diastolic noncompacted to compacted ratio of 2.5 in the whole apical wall and mid-ventricular anterolateraland inferolateral walls. Delayed gadolinium contrast-enhanced MRI revealed subepicardial mid-wall hyperenhancement of the midventricular anteroseptal and inferoseptal walls, which suggested myocardial fibrosis. We review the pathophysiology, clinical characteristics, and diagnostic approach of the left ventricular noncompaction associated with congestive heart failure.

MeSH Terms

Adult
Dyspnea
Echocardiography
Estrogens, Conjugated (USP)
Fibrosis
Gadolinium
Heart
Heart Failure
Heart Ventricles
Humans
Magnetic Resonance Imaging
Male
Estrogens, Conjugated (USP)
Gadolinium

Figure

• 

  Fig. 1 A 38-year-old male with dyspnea. A. Plain chest radiograph demonstrated cardiomegaly, pulmonary congestion and mild both pleural effusion. B. Follow-up chest radiograph after adequate treatment showed improvement of pulmonary congestion and both pleural effusion. C. Apical 4-chamber view of transthoracic echocardiography showed typical deep recesses and prominent trabeculations involving the left ventricular apex and lateral wall (arrows). D. Parasternal short axis view of transthoracic echocardiography demonstrated the noncompacted myocardium of left ventricle (arrows). E. Static 4-chamber view of cine MR image showed prominent ventricular myocardial trabeculations and deep intertrabecular recesses communicating with the ventricular cavity, compromising the mid-ventricular lateral wall and the apex of the left ventricle (arrows). F. Short-axis view presented two myocardial layers with different degrees of tissue compaction (compacted and noncompacted, arrows). The end-diastolic noncompacted to compacted ratio measured 2.5. G. Short-axis cine MR images during diastolic (upper images) and systolic (lower images) phases showed global hypokinesia and prominent noncompacted myocardium. H. Basal to apical short-axis images acquired 15 minutes after the injection of the contrast agent showed poorly marginated enhancement of anterior ventricular wall.

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