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Unique Association of Rare Cardiovascular Disease in an Athlete With Ventricular Arrhythmias.

Santomauro V, Contursi M, Dellegrottaglie S, Borsellino G - Transl Med UniSa (2014)

Bottom Line: Ventricular arrhythmias are a leading cause of non-elegibility to competitive sport.The failure to detect a significant organic substrate in the initial stage of screening does not preclude the identification of structural pathologies in the follow-up by using advanced imaging techniques.Here we report the case of a senior athlete judged not elegible because an arrhythmia with the morphology consistent with the origin of the left ventricle, in which subsequent execution of a cardiac MR and a thoracic CT scan has allowed the identification of an unique association between an area of myocardial damage, probable site of origine of the arrhythma, and a rare aortic malformation.

View Article: PubMed Central - PubMed

Affiliation: Sports Cardiology Center, "Check-Up Day-Surgery" Centro Polispecialistico, Salerno, Italy.

ABSTRACT
Ventricular arrhythmias are a leading cause of non-elegibility to competitive sport. The failure to detect a significant organic substrate in the initial stage of screening does not preclude the identification of structural pathologies in the follow-up by using advanced imaging techniques. Here we report the case of a senior athlete judged not elegible because an arrhythmia with the morphology consistent with the origin of the left ventricle, in which subsequent execution of a cardiac MR and a thoracic CT scan has allowed the identification of an unique association between an area of myocardial damage, probable site of origine of the arrhythma, and a rare aortic malformation.

No MeSH data available.


Related in: MedlinePlus

Cardiac MRI.On the left. Short-axis cine image: focal intramyocardial area showing “indian-ink sign” (arrow). At the Center. Fast-spin echo T1-weighted image obtained at the same level: area of signal hyperintesity (arrow) compatible with fatty infiltration. Right. Late post-gadolinium short-axis image with focal intramyocardial areas of hyperenhancement (arrows) involving the septal interventricular junctions (suggestive for myocardial fibrosis with non-ischemic pattern of distribution).
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f2a-tm-12-60: Cardiac MRI.On the left. Short-axis cine image: focal intramyocardial area showing “indian-ink sign” (arrow). At the Center. Fast-spin echo T1-weighted image obtained at the same level: area of signal hyperintesity (arrow) compatible with fatty infiltration. Right. Late post-gadolinium short-axis image with focal intramyocardial areas of hyperenhancement (arrows) involving the septal interventricular junctions (suggestive for myocardial fibrosis with non-ischemic pattern of distribution).

Mentions: A complete diagnostic work-up, including echocardiogram, stress test, ventriculography and coronary angiogram, failed to detect any organic substrate of the arrhythmia. No tachicardia was inducible by ventricular stimulation performed with an aggressive protocol. However the athlete was judged not eligible for competition due to the high weight of arrhytmic events and high heart rate of ventricular tachycardia (R-R cycle of less than 400 msec on ECG). In the follow-up period a cardiac MRI was performed showing normal left and right ventricular cavity dimensions and systolic function on cine images. At the level of the interventricular septum, pre- and post-contrast morphological images detected a focal area of fibrofatty replacement involving the inferior interventricular junction (Fig. 2A). The same MRI exam detected the presence of a vascular malformation consisting of right-sided aortic arch with atypical aortic arch configuration (incomplete aortic vascular ring) and the left subclavian artery arising from a dilated segment of the distal arch (Kommerell’s diverticulum) (Fig. 2 B).


Unique Association of Rare Cardiovascular Disease in an Athlete With Ventricular Arrhythmias.

Santomauro V, Contursi M, Dellegrottaglie S, Borsellino G - Transl Med UniSa (2014)

Cardiac MRI.On the left. Short-axis cine image: focal intramyocardial area showing “indian-ink sign” (arrow). At the Center. Fast-spin echo T1-weighted image obtained at the same level: area of signal hyperintesity (arrow) compatible with fatty infiltration. Right. Late post-gadolinium short-axis image with focal intramyocardial areas of hyperenhancement (arrows) involving the septal interventricular junctions (suggestive for myocardial fibrosis with non-ischemic pattern of distribution).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592045&req=5

f2a-tm-12-60: Cardiac MRI.On the left. Short-axis cine image: focal intramyocardial area showing “indian-ink sign” (arrow). At the Center. Fast-spin echo T1-weighted image obtained at the same level: area of signal hyperintesity (arrow) compatible with fatty infiltration. Right. Late post-gadolinium short-axis image with focal intramyocardial areas of hyperenhancement (arrows) involving the septal interventricular junctions (suggestive for myocardial fibrosis with non-ischemic pattern of distribution).
Mentions: A complete diagnostic work-up, including echocardiogram, stress test, ventriculography and coronary angiogram, failed to detect any organic substrate of the arrhythmia. No tachicardia was inducible by ventricular stimulation performed with an aggressive protocol. However the athlete was judged not eligible for competition due to the high weight of arrhytmic events and high heart rate of ventricular tachycardia (R-R cycle of less than 400 msec on ECG). In the follow-up period a cardiac MRI was performed showing normal left and right ventricular cavity dimensions and systolic function on cine images. At the level of the interventricular septum, pre- and post-contrast morphological images detected a focal area of fibrofatty replacement involving the inferior interventricular junction (Fig. 2A). The same MRI exam detected the presence of a vascular malformation consisting of right-sided aortic arch with atypical aortic arch configuration (incomplete aortic vascular ring) and the left subclavian artery arising from a dilated segment of the distal arch (Kommerell’s diverticulum) (Fig. 2 B).

Bottom Line: Ventricular arrhythmias are a leading cause of non-elegibility to competitive sport.The failure to detect a significant organic substrate in the initial stage of screening does not preclude the identification of structural pathologies in the follow-up by using advanced imaging techniques.Here we report the case of a senior athlete judged not elegible because an arrhythmia with the morphology consistent with the origin of the left ventricle, in which subsequent execution of a cardiac MR and a thoracic CT scan has allowed the identification of an unique association between an area of myocardial damage, probable site of origine of the arrhythma, and a rare aortic malformation.

View Article: PubMed Central - PubMed

Affiliation: Sports Cardiology Center, "Check-Up Day-Surgery" Centro Polispecialistico, Salerno, Italy.

ABSTRACT
Ventricular arrhythmias are a leading cause of non-elegibility to competitive sport. The failure to detect a significant organic substrate in the initial stage of screening does not preclude the identification of structural pathologies in the follow-up by using advanced imaging techniques. Here we report the case of a senior athlete judged not elegible because an arrhythmia with the morphology consistent with the origin of the left ventricle, in which subsequent execution of a cardiac MR and a thoracic CT scan has allowed the identification of an unique association between an area of myocardial damage, probable site of origine of the arrhythma, and a rare aortic malformation.

No MeSH data available.


Related in: MedlinePlus