J Cardiovasc Ultrasound.  2012 Jun;20(2):103-107. 10.4250/jcu.2012.20.2.103.

Isolated Left Ventricular Noncompaction with a Congenital Aneurysm Presenting with Recurrent Embolism

• Ahn JH
• Koh JS
• Park JR
• Park MJ
• Min JH
• Cho SY
• Lee EJ
• Kim WC
• Kim KH

• KMID: 2177375
• DOI: http://doi.org/10.4250/jcu.2012.20.2.103

Abstract

Isolated left ventricular noncompaction (LVNC) is a rare disorder caused by embryonic arrest of compaction. LVNC is sometimes associated with other congenital cardiac disorders; however, there have been few reports of its coexistence with a left ventricular aneurysm. A 40-year-old woman was admitted to our hospital for renal infarction. She had a history of embolic cerebral infarction 10 years ago. Transthoracic echocardiography showed prominent trabeculae and deep intertrabecular recesses which are filled with blood from the left ventricular (LV) cavity. A thrombus in the akinetic apical wall was confirmed by contrast echocardiography. Using cardiac computed tomography and magnetic resonance imaging, we rejected a possible diagnosis of suspicion of coronary artery disease. She was diagnosed LVNC with a thrombus in apical aneurysm. Here, we report the first patient in Korea known to have LVNC accompanying LV congenital aneurysm presenting with recurrent embolism.

Keyword

Left ventricular noncompaction; Left ventricular aneurysm

MeSH Terms

Adult
Aneurysm
Cerebral Infarction
Coronary Artery Disease
Echocardiography
Embolism
Female
Humans
Infarction
Korea
Magnetic Resonance Imaging
Thrombosis

Figure

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  Fig. 1 Transthoracic echocardiography. (A) A modified 4-chamber view showing an apical aneurysm (An) and prominent trabeculations (arrows) on the basal to mid-lateral wall. (B) Color Doppler image showing blood flow in the recess between trabeculae. (C and D) Apical level of short axis view showing trabeculations and perfusion in intertrabecular recesses on color Doppler imaging.

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  Fig. 2 Apical 4-chamber view (A and B) and apical 2-chamber view (C and D) in transthoracic echocardiography, showing increased trabeculations of the septal and inferior wall (arrows) and an apical aneurysm (An). The apical aneurysm of akinetic motion was defined at end-diastole (A and C) and end-systole (B and D). LV: left ventricle.

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  Fig. 3 Apical focusing image of apical long axis view (A) and apical short axis view (B) in contrast echocardiography, showing a thrombus (arrow) in the apical aneurysm. LV: left ventricle, An: aneurysm.

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  Fig. 4 Coronary computed tomography angiography, showing normal coronary artery (A), thrombus (arrow) in an apical aneurysm (B), and a thick noncompacted layer (C). LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, LA: left atrium, LV: left ventricle, RV: right ventricle.

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  Fig. 5 Cardiac magnetic resonance imaging, showing a thin compacted layer preserving contractility (thick arrow) and an akinetic aneurysm (thin arrows) at end-diastole (A) and end-systole (B). Ao: aorta, LA: left atrium, LV: left ventricle.

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