Left ventricular restoration surgery for isolated left ventricular noncompaction: Report of the first successful case

Aortic root replacement for aortic root aneurysm with severe aortic regurgitation and incidentally detected left ventricular hyper-trabeculation/noncompaction

A 54-year-old male with severe aortic regurgitation (AR), aortic root aneurysm, left ventricular hyper-trabeculation/noncompaction (LVHT) and systolic dysfunction with a left ventricular ejection fraction (LVEF) of 52% underwent successful aortic root replacement. Intraoperative video-endoscopy confirmed LVHT. At 3-year follow-up, he remains in an excellent clinical condition and echocardiography shows an improvement of the systolic function, LVHT and LVEF of 66%. Timely surgical correction of severe AR may also lead to improvement of systolic function in a patient with LVHT.

Effect of Noncompacted Myocardial Resection on Isolated Left Ventricular Noncompaction

Isolated left ventricular noncompaction, where broad trabeculae and deep intertrabecular recesses are observed in the left ventricular myocardium resulting from an arrest in normal embryogenesis, is a rare cardiomyopathy. We present a report on isolated trabeculectomy and postoperative echocardiographic follow-up showing recovery of cardiac function for isolated left ventricular noncompaction.

Left ventricular noncompaction cardiomyopathy: updated review

The first case of noncompaction was described in 1932 after an autopsy performed on a newborn infant with aortic atresia/coronary-ventricular fistula. Isolated noncompaction cardiomyopathy was first described in 1984. A review on selected/relevant medical literature was conducted using Pubmed from 1984 to 2013 and the pathogenesis, clinical features, and management are discussed. Left ventricular noncompaction (LVNC) is a relatively rare congenital condition that results from arrest of the normal compaction process of the myocardium during fetal development. LVNC shows variability in its genetic pattern, pathophysiologic findings, and clinical presentations. The genetic heterogeneity, phenotypical overlap, and variety in clinical presentation raised the suspicion that LVNC might just be a morphological variant of other cardiomyopathies, but the American Heart Association classifies LVNC as a primary genetic cardiomyopathy. The familiar type is common and follows a X-linked, autosomal-dominant, or mitochondrial-inheritance pattern (in children). LVNC can occur in isolation or coexist with other cardiac and/or systemic anomalies. The clinical presentations are variable ranging from asymptomatic patients to patients who develop ventricular arrhythmias, thromboembolism, heart failure, and sudden cardiac death. Increased awareness over the last 25 years and improvements in technology have increased the identification of this illness and improved the clinical outcome and prognosis. LVNC is commonly diagnosed by echocardiography. Other useful diagnostic techniques for LVNC include cardiac magnetic resonance imaging, computerized tomography, and left ventriculography. Management is symptom based and patients with symptoms have a poorer prognosis. LVNC is a genetically heterogeneous disorder which can be associated with other anomalies. Making the correct diagnosis is important because of the possible associations and the need for long-term management and screening of living relatives.

Arrhythmogenic left ventricular cardiomyopathy associated with noncompaction

A 46-year-old woman was admitted to our hospital because of progressive exertional dyspnea and occasional premature ventricular contraction. An enhanced computed tomographic scan revealed partial defect of the left ventricular myocardium and prominent trabecular meshwork at the same thin-wall segment. She underwent resection and endoventricular patch plasty using cardiopulmonary bypass. Histopathologic examination showed transmural fibro-fatty replacement of the myocardium, with an extremely thickened endocardium. Here we report an extremely rare case of surgery in a patient with arrhythmogenic left ventricular cardiomyopathy associated with left ventricular noncompaction.

A rare case of coronary artery bypass grafting in a patient with left ventricular noncompaction

Ventricular myocardium noncompaction is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. Initially the noncompaction of the left ventricle was described in the pediatrics population with poor prognosis, but recent reports have noticed the presence of this pathology in the adult population. We describe a 54-year-old man with isolated noncompaction of the left ventricle who had ischemic heart disease and was successfully treated with bypass surgery.

The treatment of noncompaction of ventricular myocardium

AIMS

Critically reexamine and place in perspective the most appropriate therapeutic strategies for patients noncompaction of ventricular myocardium.

RESULTS

Specific treatments are not available for the majority of patients with noncompaction of ventricular myocardium currently. Treatment of patients with noncompaction of ventricular myocardium could be similar to patients with other cardiomyopathies, especially dialated cardiomyopathy, and therefore, the primary aims of treatment are to control symptoms, disease progression, and complications, which should include appropriate treatment for heart failure, management of arrhythmias, and oral anticoagulation to prevent systemic emboli.

CONCLUSION

Among the many challenges facing clinicians treating patients with noncompaction of ventricular myocardium are the detection of early disease, the identification of the predominant mechanism of left ventricular dysfunction, and the development of treatments that target the initiating mechanism of disease. Nevertheless, there have been major advances in our understanding of the genetic basis of noncompaction of ventricular myocardium, and recent advances in the drug therapy and nondrug therapy of noncompaction of ventricular myocardium have substantially improved the outlook for many patients. The rapid pace of current research and the development of new treatments for the management of both early and late disease augur well for the future.

Coronary artery bypass graft and mitral valvuloplasty in a patient with isolated ventricular non-compaction

A case of isolated ventricular non-compaction associated to three-vessel disease and a mitral regurgitation is described. The patient underwent triple coronary artery bypass graft and restrictive mitral annuloplasty. The postoperative course was unsuccessful despite the very depressed left ventricular (LV) function. At two years follow-up, no major adverse cardiac event has occurred and the LV function was slightly improved.

Left ventricular noncompaction

According to the World Health Organization classification of cardiomyopathies, left ventricular noncompaction is still an unclassified cardiomyopathy. In 2006, the American Heart Association classified this entity as a primary cardiomyopathy of genetic origin. In 2008, the European Society of Cardiology updated the classification scheme similar to the World Health Organization classification. At present, there is no consensus on the diagnostic criteria, and diagnosis is based on the morphologic features identified by cardiac imaging studies or at autopsy. Due to lack of standardization of the diagnostic criteria and little awareness of this condition among clinicians, the true prevalence of this disease is not clear. There is no specific therapy for this condition. However, it seems prognosis is much better than initially reported. The current status of diagnosis, prognosis, and management of isolated noncompaction in adults is discussed in this review.