CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 3, April 2013
AFRICA
e1
Case Report
Left ventricular non-compaction in pregnancy
ISMAIL DOGU KILIC, HALIL TANRIVERDI, HARUN EVRENGUL, SUKRIYE USLU, MUSTAFA AZMI SUNGUR
Abstract
Left-ventricular non-compaction (LVNC) represents an
arrest in the normal process of myocardial compaction,
resulting in multiple, prominent, persistant trabeculations
and deep inter-trabecular recesses communicating with the
ventricular cavity. LVNC is a rarely encountered cardiomyo-
pathy and few cases have been reported in pregnancy. In this
case report we present a patient who referred to our clinic
with symptoms of heart failure during pregnancy and whose
echocardiographic examination revealed prominent trabecu-
lations in the left ventricle.
Keywords:
pregnancy, non-compaction, heart failure
Submitted 15/4/12, accepted 23/10/12
Cardiovasc J Afr
2013;
24
: e1–e2
DOI: 10.5830/CVJA-2012-075
Left ventricular non-compaction (LVNC), also known as ‘spongy
myocardium’, represents an arrest in the normal process of
myocardial compaction, resulting in the persistence of multiple
prominent trabeculations and deep inter-trabecular recesses
communicating with the ventricular cavity.
1,2
The presentation
may follow a spectrum from no symptoms to poorly functioning
dilated ventricles, a high incidence of ventricular arrhythmias,
and systemic emboli.
3
The diagnosis is usually made using echocardiography
and, increasingly, magnetic resonance imaging (MRI), despite
lacking universally accepted criteria.
4
Multi-detector computed
tomography (CT) may also help detect the abnormal architecture
of the left ventricle.
5
Left ventricular non-compaction is a rare cardiomyopathy that
appears more often in children than adults, with only a few cases
reported in pregnancy.
6,7
In this report we present a patient who
was referred to our clinic with symptoms of heart failure during
pregnancy, and whose echocardiographic examination revealed
prominent trabeculations in the left ventricle.
Case report
A 19-year-old postpartum woman with dyspnoea was referred
to our clinic for further evaluation. Although she had not
experienced any cardiac symptoms during her pregnancy, she felt
progressive dyspnoea and began coughing three weeks before
her delivery. She had presented to an institution where she was
hospitalised for a few days, before she was referred to our clinic.
Her medical history was unremarkable and she had no family
history of heart failure. On physical examination, her heart rate
was 98 beats/min and her blood pressure was 100/70 mmHg. She
had jugular venous distention, diffuse crepitation rales in both
lungs, and an apical 2–3/6 pansystolic murmur.
An electrocardiogram showed non-specific T-wave changes.
Echocardiography revealed a dilated left ventricle (end-systolic
diameter 49 mm) with an ejection fraction of 20%, severe
mitral and tricuspid regurgitation, and mild aortic regurgitation.
Pulmonary artery systolic pressure was estimated at 57 mmHg
from tricuspid regurgitation. Two-dimensional echocardiography
demonstrated prominent trabeculations of the left ventricle, with
colour Doppler examination showing penetration of blood flow
into the sinusoidal recesses formed by these trabeculations (Fig. 1).
Since there is no specific therapy for the condition, the
patient was treated with beta-blockers, angiotensin converting
enzyme inhibitors, diuretics and acetyl salicylic acid. Neither
prophylactic anti-arrhythmic therapy nor anticoagulant therapy
was given. At her three-month follow-up examination, her
ejection fraction and functional capacity had improved.
Discussion
Left ventricular non-compaction is a rare congenital
cardiomyopathy caused by an arrest in the normal process of
endomyocardial morphogenesis. This disorder is characterised
by multiple prominent trabeculations and deep inter-trabecular
recesses communicating with the ventricular cavity.
1,2
Department of Cardiology, Pamukkale University School of
Medicine, Denizli, Istanbul, Turkey
ISMAIL DOGU KILIC, MD,
HALIL TANRIVERDI, MD
HARUN EVRENGUL, MD
SUKRIYE USLU, MD
Pasabahce State Hospital, Istanbul, Turkey
MUSTAFA AZMI SUNGUR, MD
Fig. 1. A: increased left ventricular trabeculation B: colour
Doppler showing blood flow between the trabeculations.
B
A
