A case of successful six consecutive deliveries in a 41-year-old woman with Uhl's anomaly

Uhl’s anomaly: rare but does exist

A 17-year-old boy presented with facial puffiness and swelling in the lower limbs for 6 months and one episode of syncope 15 days earlier. Transthoracic echocardiography showed a dilated right atrium and right ventricle with right ventricular systolic dysfunction. The free wall of the right ventricle was thinned out and devoid of myocardium and trabeculations. Cardiac magnetic resonance imaging showed an extremely dilated thin-walled right ventricle and absence of trabeculations, with no fat signal in the right ventricular wall, in contrast to that seen in arrhythmogenic ventricular dysplasia, which confirmed the diagnosis of Uhl’s anomaly.

Prenatal ultrasonographic diagnosis of Uhl anomaly

Uhl anomaly is an extremely rare condition, and herein, we present a case of prenatally diagnosed Uhl anomaly to illustrate the associated echocardiographic features. Fetal echocardiography at 26 weeks indicated an enlarged right ventricle, severe tricuspid and pulmonary regurgitation, and ruptured ventricular septal aneurysm, resulting in a circular shunt. At 36 weeks, based on the presence of a thin ventricular wall and absence of apical trabeculation, a diagnosis of Uhl anomaly was made. The neonate, delivered by cesarean section, underwent main pulmonary artery ligation to eliminate the circular shunt immediately after birth. Moreover, he underwent ductus arteriosus ligation and received a pulmonary artery to aorta shunt for progressive lung congestion. He is currently well and awaiting a staged Fontan operation involving a bidirectional Glenn procedure. Understanding and accurate prenatal diagnoses of Uhl anomaly may help in parental counseling, planning appropriate perinatal care, and increasing the chances of survival.

Unusual right ventricle aneurysm and dysplastic pulmonary valve with mitral valve hypoplasia

We report a newborn with an unusual combination of aneurysmally dilated thin-walled right ventricle with hypertrophy of the apical muscles of the right ventricle. There was narrow pulmonary annulus, pulmonary regurgitation, and hypoplasia of the mitral valve and left ventricle. We propose that this heart represents a partial form of Uhl's anomaly.

A rare case of partial absence of the right ventricular musculature in asymptomatic adult man: partial Uhl's anomaly

Uhl's anomaly is a myocardial disorder of unknown cause that is characterized by complete or partial absence of the myocardium of the right ventricle. The disease may represent a cause of right heart dilatation and failure. Although most cases of Uhl's anomaly end fatally in infancy or childhood, an initial presentation during adulthood has been reported in rare cases. We report a very rare case of partial absence of the right ventricular musculature or partial Uhl's anomaly that incidentally found in asymptomatic adult man.

Uhl’s Anomaly in a Domestic Shorthair Cat

A 2-year-old, neutered male, domestic shorthair cat was presented for investigation of dyspnea and episodic weakness. Clinical and ultrasonographic features were consistent with right ventricular cardiomyopathy. Pathological findings documented Uhl’s anomaly. Although rare, Uhl’s anomaly should be a differential diagnosis for cats with right-sided congestive heart failure. In particular, Uhl’s anomaly could be misdiagnosed as arrhythmogenic right ventricular cardiomyopathy due to the similarity of clinical and echocardiographic findings.