Arrhythmogenic right ventricular cardiomyopathy

Case contributed by Tim Luijkx

Presentation

Known arrhythmogenic right ventricular cardiomyopathy. Doesn't have an ICD. History of VT ablation in right ventricular outflow tract.

Patient Data

Age: 50
Gender: Male

Body surface area: 2.11 m2.
Diameters: LV: 45 mm, RV: 40 mm, septum: 10 mm.

Functional parameters:
LV: EDV: 195 ml / ESV 80 ml / SV: 115 ml / EF: 59% 
RV: EDV: 243 ml (BSA corrected: 115 ml), was 230 ml; ESV: 142 ml/ SV: 100 ml / EF: 41% (was 47%)

Marked dyskinesia with aneurysmatic bulging of the right ventricular wall, most prominent at the apex and free wall. Normal wall motion of left ventricle. Crypt in lateral LV wall.

Delayed enhancement of basal anterior RV wall towards RVOT, apical RV and at the moderator band. Ablation scarring may cause some of this.

On T1-weighted images slight fatty change of RV free wall basally and apically. Slight subepicardial fatty change of LV posterolateral wall. 

Conclusion:

Marked wall motion abnormalities of the right ventricle with reduced function (ejection fraction 41%), findings in keeping with known ARVC.

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