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(Circulation. 2007;115:e640-e642.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Occurrence of Multiple Fibrofatty Replacements Exclusively in the Left Ventricle of a Patient With Monomorphic Sustained Ventricular Tachycardia

Koki Nakamura, MD; Nobusada Funabashi, MD; Hideyuki Miyauchi, MD; Mari Aminaka, MD; Masae Uehara, MD; Marehiko Ueda, MD; Takashi Nakayama, MD; Nakabumi Kuroda, MD; Yoshio Kobayashi, MD; Hiroyuki Takano, MD; Issei Komuro, MD

From the Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan.

Correspondence to Issei Komuro, MD, Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan. E-mail komuro-tky{at}umin.ac.jp

A 34-year-old man presented with cardiovascular syncope with sustained ventricular tachycardia (VT). ECG showed VT with morphologically right bundle-branch block with a-superior-axis. Cardioversion and endotracheal intubation were performed. After resolution of VT, a 12-lead ECG showed sinus rhythm, normal axis deviation, and isolated premature ventricular contraction of right bundle-branch block morphology with a-superior-axis. The transthoracic echocardiogram showed regional abnormality of contraction in the posterior area of the left ventricle with no abnormality of the right ventricle. Obstructive coronary heart disease was excluded by angiography but left ventriculography demonstrated regional contraction abnormality in the anterolateral left ventricle. Electrophysiologically, nonsustained VT induced by programmed ventricular stimulation had similar morphology as the wide QRS tachycardia on admission, but sustained VT was not reproducibly induced. Furthermore, supraventricular tachycardia with aberrant conduction was absent, which suggests that the wide QRS tachycardia could be VT. ECG-gated multislice computed tomography (Figure 1) revealed focal low-density areas (mean, –80 HU) indicative of fatty infiltration in the septum and the epicardium in the posterior and lateral wall of the left ventricle; however, fat infiltration was absent in the right ventricle myocardium. Compared with the low-density area in the posterior wall, part of the low-density area in the interventricular septum was abnormally enhanced (arrowhead, Figure 1B) in the late phase, which suggests the presence of fibrosis around fat infiltration.

View larger version (168K): [in this window] [in a new window]   Figure 1. Axial source (A and B) and multiplanar reconstruction images of long axis (C) and short axis (D) of the left ventricle of enhanced ECG-gated multislice computed tomography revealed focal low-density areas (mean, –80 HU) indicative of fatty infiltration in the interventricular septum and along the epicardium in the posterior and lateral walls of the left ventricle. A, C, and D were acquired in the early phase, and B was acquired in the late phase; A and B were axial source images of the same level. Compared with the low-density area in the posterior wall, part of the low-density area in the interventricular septum was abnormally enhanced (), which suggests presence of fibrosis around fat infiltration.

Biopsy of left ventricular posterior wall revealed fibrofatty replacements (arrows, Figure 2); right ventricle biopsy was not performed. QRS waveform suggested VT was likely caused by arrhythmia that resulted from ventricular dysplasia. A cardioverter defibrillator was implanted and its proper discharge for sustained VT was confirmed.

View larger version (84K): [in this window] [in a new window]   Figure 2. Microscopic examination of myocardial biopsy specimen obtained from the posterior wall of the left ventricle on day 20 of hospitalization demonstrated fibrofatty replacement. Arrows indicate hematoxylin-eosin stain. Magnification in A, x100; in B, x200.

	Acknowledgments

 
Disclosures

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nakamura, K. Articles by Komuro, I. Search for Related Content PubMed Articles by Nakamura, K. Articles by Komuro, I. Related Collections CT and MRI