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Dilated Cardiomyopathy in Non Compaction Left Ventricle with Systolic Impaired Function and Severe Functional Mitral Regurgitation: Echocardiography and Cardiac Magnetic Resonance Findings.A case study

Massimo Bolognesi_MDInternal General MedicineSports Cardiology Medicine CenterCardiovascular Imaging EchocardiographerCesena - ItalyMassimo Bolognesi Case Study

This report describes the echocardiographic features and magnetic resonance imaging acquired in a 50-years-old sedentary and obese woman who presented to my office complained fatigue and dyspnea on exertion as he climbed the stairs attributed to a decline in physical form. An occasional chest x-ray chest performed for cervical pain showed a enlarged cardiac silhouette for which the patient underwent echocardiographic examination (see Figure 1-2). The examination showed a left ventricular globular shape and spherical morphology due marked dilatation with reduced systolic function, a severe functional mitral regurgitation, and a marked trabeculation of the side wall of the left ventricle. A subsequent Cardiac Magnetic Resonance (see video clips 3-4-5 and Figure 3-4) confirmed the diagnosis of dilated cardiomyopathy in non-compacted myocardium with severe reduction of global contractility and low ejection fraction (EF 30%) with preserved LV stroke volume at rest.Massimo Bolognesi2

Massimo BolognesiVideo Clips 1: Two-dimensional Transthoracic Echocardiography in apical 4 chamber view showing dilated left ventricule with spherical morphology, poor global systolic function and severe functional mitral regurgitation; marked trabebeculation whit deep recess on lateral wall3

Massimo BolognesiVideo Clips 2: Two-dimensional Trans Thoracic Ecocardiography in Left Parasternal Long Axis View shows dilated left ventricle with poor systolic function and tethering of mitral valve by leaflet malcoaptation that cause severe mitral regurgitation 4

ABMassimo BolognesiFigure 1 Panel A shows ApicaL 4 chamber view in Dilated Cardiomyopathy with Severe Functional Mitral Regurgitation and non-compacted myocardium on the lateral wall; Panel B shows estimated Ejection Fraction of Left Ventricle with Simpson method assessment5

Massimo BolognesiFigure 2 shows M-Mode of Transmitral Diastolic Flow with Restrictive Pattern 6

Cine SAXMassimo BolognesiCourtesy of Prof. Filippo Cademartiri Video Clips 3: Cardiac Magnetic Resonance showing Cine SAX view7

Cine RAOMassimo BolognesiCourtesy of Prof. Filippo Cademartiri Video Clips 4: Cardiac Magnetic Resonance showing Cine RAO8

Cine 4CHMassimo BolognesiCourtesy of Prof. Filippo Cademartiri - Video Clips 5: Cardiac Magnetic Resonance showing Cine 4 CH9

14mm7mm17mm8mm12mm7mm10mm10mmDiastDiastMassimo BolognesiFigure 3: Cardiac Magnetic Resonance shows Left ventricular non-compacted myocardium on the inferolateral and lateral wall10

Massimo BolognesiFigure 4 shows a focused non-compacted myocardium on the sub-endocardial LV anterolateral basal medium wall11