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(Circulation. 1998;98:2638-2639.)
© 1998 American Heart Association, Inc.

Images in Cardiovascular Medicine

Midmural Fibrosis of Left Ventricle Due to Selenium Deficiency

Moriaki Inoko, MD; Takashi Konishi, MD; Satoru Matsusue, MD; Yoichiro Kobashi, MD

From the Departments of Cardiology (M.I., T.K.), Abdominal Surgery (S.M.), and Pathology (Y.K.), Tenri Hospital, Tenri, Japan.

Correspondence to Takashi Konishi, MD, PhD, Department of Cardiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632, Japan.

A 38-year-old man with Crohn's disease had been receiving total parenteral nutrition for 16 years, from the age of 22 years. At the age of 28 years, he had rapidly developing heart failure and ventricular premature beats associated with selenium (Se) deficiency. Laboratory data included a serum Se concentration of 62 µg/L (normal value, 80 to 230 µg/L), an erythrocyte Se concentration of 93 µg/L (normal value, 100 to 194 µg/L), and an erythrocyte glutathione peroxidase activity of 5.4 U/g hemoglobin (normal value, 25.3 to 45.3 U/g hemoglobin). Supplements of Se improved his condition but did not normalize the left ventricular dysfunction.

The patient was given Se supplements and was free from symptoms of heart failure for 11 years, but the echocardiographic findings gradually deteriorated. He was admitted with congestive heart failure at the age of 38 years. He improved with the administration of digitalis and diuretics and left the hospital. Five days after discharge, he suddenly died at his home. At autopsy, the heart was markedly enlarged and weighed 490 g. Microscopic examination of the myocardium disclosed scattered and irregular areas of myocardial loss and fibrous replacement that were localized to the midmural regions in the left ventricular free wall (Figures 1 and 2). In the interventricular septum, fibrosis was linear and restricted to the right ventricular side. The subendocardial region and the right ventricular free wall were relatively spared.

View larger version (171K): [in this window] [in a new window]   Figure 1. Cross-sectional tissue slices of heart at level of left ventricular papillary muscles. Scattered areas of myocardial loss were localized to midmural regions in left ventricular free wall. Fibrosis was linear and restricted to right ventricular side in interventricular septum. Subendocardial region and right ventricular free wall were relatively spared. Azan staining.

View larger version (135K): [in this window] [in a new window]   Figure 2. Sections of left ventricle presented at a magnification of x40. Fibrosis in midmural regions was irregular and was not distributed along with specific coronary perfusion. Azan staining.

Johnson et al¹ described an "occidental" patient in whom Se deficiency became associated with dilated cardiomyopathy; autopsy showed similar subepicardial fibrosis. We speculate that the midmural change is characteristic of cardiomyopathy related to Se deficiency. Once fully developed, the left ventricular dysfunction may be irreversible even after use of Se supplements.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke's Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke's Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1–267, Houston, TX 77030.

References

1. Johnson RA, Baker SS, Fallon JT, Maynard EP III, Ruskin JN, Wen Z, Ge K, Cohen HJ. An occidental case of cardiomyopathy and selenium deficiency. N Engl J Med. 1981;304:1210–1212.[Medline] [Order article via Infotrieve]
   

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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 Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Inoko, M. Articles by Kobashi, Y. Search for Related Content PubMed PubMed Citation Articles by Inoko, M. Articles by Kobashi, Y.