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///2009 Abstract Details
2009 Abstract Details2019-08-03T15:55:31-05:00

Ventricular tachycardia from undiagnosed noncompaction of the left ventricle in a nulliparous parturient.

Abstract Number: 194
Abstract Type: Case Report/Case Series

Susan M Moeschler M.D.1 ; Katherine Arendt M.D.2; William Oliver M.D.3

A 30 year-old gravida 1 nulliparous parturient at 32 weeks gestation presented with dyspnea, light-headedness, palpitations and a prior presyncopal episode. An electrocardiogram showed a wide complex tachycardia which was successfully treated with procainamide. Echocardiogram showed an ejection fraction (EF) of 35 % and noncompaction of the left ventricle (NCLV) with a noncompaction to compaction ratio of 2.3 to 1 (diagnostic ratio defined as noncompaction to compaction greater than 2 to 1)1. Over the next two days, she continued to exhibit signs of heart failure and paroxysms of ventricular tachycardia (VT). It was decided to proceed with cesarean delivery at 32 weeks gestation. General anesthesia was induced with 1000 mcg fentanyl, 70 mg ketamine and 140 mg succinylcholine. Intraoperatively, she had three runs of VT each of which was successfully defibrillated and she was started on an amiodarone infusion. A post-operative echocardiogram showed further LV dilatation and a reduced EF to 25%. Eight hours post-partum she received an intra-aortic balloon pump, to decrease her LV afterload, which was removed after 48 hours. An internal cardiac defibrillator was placed on post-partum day seven and she was discharged from the intensive care unit the following day on ace inhibitor and beta-blocker therapy. Nine months postpartum, the patient was asymptomatic with an EF of 55%.

Noncompaction of the ventricular myocardium results from abnormal formation of the myocardial cells during embryology. The presence of myocardial trabeculations and deep recesses within the left ventricle are pathognomonic for NCLV. Noncompaction syndrome has been reported to present clinically in the form of heart failure, arrhythmias, embolic events and sudden death. Mortality from NCLV is estimated as high as 5% per year.4 It has recently been reported in parturients as mimicking peripartum cardiomyopathy.1,3 Prior presentations of undiagnosed NCLV during pregnancy include edema and headache3dyspnea and dizziness,3 and dyspnea only.1 Here, we present a parturient who presents with VT from NCLV and with careful management has a successful outcome.

1 Bahl A, Swamy A, Sharma Y, Kumar N. Isolated noncompaction of left ventricle presenting as peripartum cardiomyopathy. International Journal of Cardiology 2006. 109: 422-423

2 Jenni, R. Et al. Echocardiographic and pathoanatomical characteristics of isolated left ventricular non-compaction: a step towards classification as a distinct cardiomyopathy. Heart 2001;86:666-671

3 Patel C, Shirali G, Pereira N. Left Ventricular Noncompaction Mimicking Peripartum Cardiomyopathy Journal of the American Society of Echocardiography 2007. 20: 1009.e9-1009.e12

4. Stllberger , M . Et al. Prognosis of left ventricular hypertrabeculation/noncompaction is dependent on cardiac and neuromuscular comorbidity. International Journal of Cardiology , 121:2, 189-193 C.

SOAP 2009