Tissue Doppler imaging and contrast-enhanced cardiac magnetic resonance in primary cardiac amyloidosis.

A 64-year-old female presented with biventricular heart failure. Echocardiography revealed features suggestive of amyloidosis, including segmental impairment of longitudinal strain (rate) in the septal and anterior segments, which matched delayed gadolinium-enhanced cardiac magnetic resonance. Guided endomyocardial biopsy confirmed the presence of perivascular amyloid deposits. Tissue Doppler and gadolinium-enhanced magnetic resonance may be helpful in delineating cardiac amyloidosis.

Cardiac magnetic resonance predicts reversibility of cocaine-induced ventricular dysfunction.

A 30-year-old Caucasian female was admitted with severe biventricular congestive heart failure secondary to cocaineinduced cardiomyopathy. Contrast-enhanced cardiac magnetic resonance did not reveal myocardial oedema or focal fibrosis. The systolic ventricular function recovered fully after 10 weeks of abstinence from cocaine and supportive medical treatment. This case report is the first to describe findings with magnetic resonance for this condition, and briefly discusses its potential value in the evaluation of patients with cocaine-induced heart failure.

Myocardial infarcts in a patient with a single right sided coronary ostium and interarterial course of the circumflex artery: the role of multi-modality imaging.

A solitary coronary ostium, in the absence of other congenital cardiovascular abnormalities, is a rare finding at angiography, and may be associated with myocardial ischemia and sudden cardiac death. We present a 46-year-old female who presented with a non-ST-segment-elevation myocardial infarct in whom the diagnosis of a single coronary artery with right sided ostium was made during diagnostic coronary angiography. Multi-detector computed tomography and gadolinium-enhanced cardiovascular magnetic resonance were valuable in delineating the extremely rare IIE1 coronary anatomy, the localization and the extent of myocardial necrosis.

FDG-PET and MIBI-Tc SPECT as follow-up tools in a patient with cardiac sarcoidosis requiring a pacemaker.

A 63-year-old man presented with recent-onset symptoms secondary to third-degree atrio-ventricular block, for which a dual-chamber pacemaker was inserted. Additional investigations resulted in the diagnosis of cardiac sarcoidosis. FDG-PET and MIBI-technetium SPECT were used as follow-up tools for monitoring active granulomatous myocardial infiltration.

Resolution of nodular myocardial tuberculosis demonstrated by contrast-enhanced magnetic resonance imaging.

In sub-Saharan Africa, pericardial tuberculosis is frequently diagnosed in HIV sero-positive patients. Myocardial involvement has only rarely been reported. We present an HIV sero-positive patient in whom both pericardial and myocardial tuberculosis were diagnosed, and highlight the value of cardiac magnetic resonance imaging in the diagnosis and management of this condition.

Tuberculous effusive-constrictive pericarditis.

Infection with Mycobacterium tuberculosis and the human immunodeficiency virus has reached epidemic proportions in South Africa. Cardiac involvement occurs in approximately one per cent of patients suffering from active tuberculosis. This concerns predominantly pericardial involvement, resulting in chronic pericardial effusions, cardiac tamponade and constrictive pericarditis. Effusive-constrictive pericarditis is a clinical haemodynamic syndrome in which constriction by the visceral pericardium occurs in the presence of a tense effusion in a free pericardial space. We present a patient who was diagnosed with this condition, and highlight the value of contrast-enhanced magnetic resonance imaging in demonstrating the underlying structural and functional abnormalities.

Tissue Doppler imaging in cardiac sarcoidosis.

A middle-aged African lady, who presented with ventricular tachycardias, mitral valve regurgitation and congestive heart failure, was diagnosed with cardiac sarcoidosis. Tissue Doppler imaging demonstrated abnormalities suggestive of myocardial scar, which was confirmed by contrast-enhanced cardiac magnetic resonance.

Pulmonary arterial hypertension after splenectomy for hereditary spherocytosis.

Hereditary spherocytosis consists of a group of haemolytic anaemias caused by defects in the proteins involved in the vertical interactions between the membrane skeleton and the lipid bilayer of the red blood cell. Inheritance is most commonly autosomal dominant with variable expression. Splenectomy may be indicated because of anaemia or for the prevention of gall-stones. We describe a patient who presented with symptoms of pulmonary hypertension 32 years after splenectomy. Idiopathic pulmonary arterial hypertension (IPAH) and chronic thromboembolic pulmonary hypertension (CTEPH) have been associated with splenectomy, while chronic haemolysis may result in haemolysis-associated pulmonary hypertension. We briefly discuss the current views on the pathophysiology, diagnosis and management of this rare condition.

Comprehensive assessment of left ventricular pseudo-aneurysms with magnetic resonance imaging.

In a small number of patients, myocardial infarction, trauma, infection or cardiac surgery are complicated by incomplete wall rupture and pseudo-aneurysm formation. We describe the advances made in the non-invasive assessment of this condition with the introduction of magnetic resonance imaging (MRI) and discuss the value of specific MRI techniques for comprehensive structural and functional cardiac assessment.

Left ventricular viability in a patient with heart failure due to left main stem stenosis, predicted by SPECT and gadolinium-enhanced magnetic resonance but not by dobutamine stress echocardiography.

A 54-year-old woman with occlusive disease of the distal abdominal aorta was referred for pre-operative risk assessment, and was diagnosed with severe impairment of the left ventricular function due to left main stem coronary artery stenosis. Low-dose dobutamine stress echocardiography did not demonstrate contractile reserve, while gadoliniumenhanced cardiac magnetic resonance (CMR) suggested viability of the left ventricle. The patient underwent coronary bypass grafting, and had an uncomplicated post-operative course, with improvement of the left ventricular ejection fraction from the initial 20% to 44% after four months. The value of CMR in determining myocardial viability in left main stem stenosis has not previously been reported.

[Cardiac sarcoidosis: improved prognosis through new diagnostic tests and treatment]. / Cardiale sarcoïdose: betere prognose door nieuwe diagnostiek en behandeling.

Cardiac sarcoidosis was diagnosed in 3 patients: 2 men aged 52 and 51 years, respectively, and a woman aged 55 years. Both men had ventricular tachycardia. In the first man, a right-ventricle biopsy revealed a non-caseating granuloma. The second man had active granulomatous cardiac infiltration, according to a gallium scintigram. The first man recovered after receiving immunosuppression, heart-failure medication, and an implantable defibrillator; the second received the same plus radio-frequency catheter ablation, but experienced serious heart failure. The woman was being treated for pulmonary sarcoidosis but complained of progressive cardiac symptoms. She recovered after receiving heart-failure medication, immunosuppression, and a biventricular pacemaker. Sarcoidosis is a multi-system granulomatous disorder of unknown aetiology with cardiac involvement in 20 to 30% of patients, resulting in severe morbidity and mortality. With the help ofgadolinium MRI and positron emission tomography (PET), these conditions can be detected at an earlier stage, which allows for improved evaluation of the efficacy of available therapies. The use of resynchronisation therapy and implantable defibrillators has improved the prognosis of patients with cardiac sarcoidosis.

Cardiac involvement of Churg Strauss syndrome demonstrated by magnetic resonance imaging.

Churg Strauss syndrome (CSS) may lead to cardiac involvement in up to 60% of patients. The myocardium, coronary vasculature, valves and pericardium may be affected. This results in significant morbidity and mortality, accounting for 48% of deaths due to CSS. Cardiac magnetic resonance imaging (CMR) is used to evaluate cardiac structure and function, and is able to evaluate myocardial perfusion and delineate scar tissue. We are the first to demonstrate these features in a 53-year-old CSS patient who presented with palpitations and atypical chest pains, and was found to have myocardial perfusion defects and scar tissue, most likely secondary to vasculitis of the small myocardial vasculature and myocardial infiltration.