Right ventricular sarcoidosis: is it time for updated diagnostic criteria?
A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years...
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| Veröffentlicht in: | Texas Heart Institute journal 2014-04, Vol.41 (2), p.203-207 |
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| creator | Vakil, Kairav Minami, Elina Fishbein, Daniel P |
| description | A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy. |
| doi_str_mv | 10.14503/THIJ-12-3086 |
| format | Article |
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The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy.</description><identifier>ISSN: 0730-2347</identifier><identifier>EISSN: 1526-6702</identifier><identifier>DOI: 10.14503/THIJ-12-3086</identifier><identifier>PMID: 24808785</identifier><language>eng</language><publisher>United States: Texas Heart® Institute, Houston</publisher><subject>Arrhythmogenic Right Ventricular Dysplasia - diagnosis ; Atrial Flutter - etiology ; Atrioventricular Block - etiology ; Cardiomyopathies - complications ; Cardiomyopathies - diagnosis ; Cardiomyopathies - physiopathology ; Cardiomyopathies - surgery ; Cardiotonic Agents - therapeutic use ; Case Reports ; Diagnosis, Differential ; Disease Progression ; Echocardiography - methods ; Female ; Heart Failure - etiology ; Heart Transplantation - methods ; Heart Ventricles - pathology ; Humans ; Middle Aged ; Positron-Emission Tomography - methods ; Sarcoidosis - complications ; Sarcoidosis - diagnosis ; Sarcoidosis - physiopathology ; Sarcoidosis - surgery ; Treatment Outcome ; Ventricular Dysfunction, Right - diagnosis ; Ventricular Dysfunction, Right - etiology ; Ventricular Dysfunction, Right - physiopathology ; Ventricular Dysfunction, Right - surgery</subject><ispartof>Texas Heart Institute journal, 2014-04, Vol.41 (2), p.203-207</ispartof><rights>2014 by the Texas Heart® Institute, Houston 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c387t-9b7056995710f0fe29bb74b5b841e49fec4f74346bb87d90c169ca0f2f1903783</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004474/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4004474/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24808785$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vakil, Kairav</creatorcontrib><creatorcontrib>Minami, Elina</creatorcontrib><creatorcontrib>Fishbein, Daniel P</creatorcontrib><title>Right ventricular sarcoidosis: is it time for updated diagnostic criteria?</title><title>Texas Heart Institute journal</title><addtitle>Tex Heart Inst J</addtitle><description>A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy.</description><subject>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</subject><subject>Atrial Flutter - etiology</subject><subject>Atrioventricular Block - etiology</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiomyopathies - diagnosis</subject><subject>Cardiomyopathies - physiopathology</subject><subject>Cardiomyopathies - surgery</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Case Reports</subject><subject>Diagnosis, Differential</subject><subject>Disease Progression</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Heart Failure - etiology</subject><subject>Heart Transplantation - methods</subject><subject>Heart Ventricles - pathology</subject><subject>Humans</subject><subject>Middle Aged</subject><subject>Positron-Emission Tomography - methods</subject><subject>Sarcoidosis - complications</subject><subject>Sarcoidosis - diagnosis</subject><subject>Sarcoidosis - physiopathology</subject><subject>Sarcoidosis - surgery</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Right - diagnosis</subject><subject>Ventricular Dysfunction, Right - etiology</subject><subject>Ventricular Dysfunction, Right - physiopathology</subject><subject>Ventricular Dysfunction, Right - surgery</subject><issn>0730-2347</issn><issn>1526-6702</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkE1LAzEURYMoWqtLt5Klm9GXj5lMXCgiapWCIHUdMpmkRqZNTTKC_97W1qKrt3iHey8HoRMC54SXwC4mo8engtCCQV3toAEpaVVUAuguGoBgUFDGxQE6TOkdABgldB8dUF5DLepygJ5e_PQt4087z9GbvtMRJx1N8G1IPl1in7DPOPuZxS5E3C9anW2LW6-n85CyN9hEn230-voI7TndJXu8uUP0en83uR0V4-eHx9ubcWFYLXIhGwFlJWUpCDhwlsqmEbwpm5oTy6WzhjvBGa-aphatBEMqaTQ46ogEJmo2RFfr3EXfzGxrVtN1pxbRz3T8UkF79f8z929qGj4VB-B8GT1EZ5uAGD56m7Ka-WRs1-m5DX1SS4WMQykZWaLFGjUxpBSt29YQUD_-1cq_IlSt_C_507_btvSvcPYNCOWBdA</recordid><startdate>20140401</startdate><enddate>20140401</enddate><creator>Vakil, Kairav</creator><creator>Minami, Elina</creator><creator>Fishbein, Daniel P</creator><general>Texas Heart® Institute, Houston</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140401</creationdate><title>Right ventricular sarcoidosis: is it time for updated diagnostic criteria?</title><author>Vakil, Kairav ; Minami, Elina ; Fishbein, Daniel P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-9b7056995710f0fe29bb74b5b841e49fec4f74346bb87d90c169ca0f2f1903783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Arrhythmogenic Right Ventricular Dysplasia - diagnosis</topic><topic>Atrial Flutter - etiology</topic><topic>Atrioventricular Block - etiology</topic><topic>Cardiomyopathies - complications</topic><topic>Cardiomyopathies - diagnosis</topic><topic>Cardiomyopathies - physiopathology</topic><topic>Cardiomyopathies - surgery</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Case Reports</topic><topic>Diagnosis, Differential</topic><topic>Disease Progression</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Heart Failure - etiology</topic><topic>Heart Transplantation - methods</topic><topic>Heart Ventricles - pathology</topic><topic>Humans</topic><topic>Middle Aged</topic><topic>Positron-Emission Tomography - methods</topic><topic>Sarcoidosis - complications</topic><topic>Sarcoidosis - diagnosis</topic><topic>Sarcoidosis - physiopathology</topic><topic>Sarcoidosis - surgery</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Right - diagnosis</topic><topic>Ventricular Dysfunction, Right - etiology</topic><topic>Ventricular Dysfunction, Right - physiopathology</topic><topic>Ventricular Dysfunction, Right - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vakil, Kairav</creatorcontrib><creatorcontrib>Minami, Elina</creatorcontrib><creatorcontrib>Fishbein, Daniel P</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Texas Heart Institute journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vakil, Kairav</au><au>Minami, Elina</au><au>Fishbein, Daniel P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Right ventricular sarcoidosis: is it time for updated diagnostic criteria?</atitle><jtitle>Texas Heart Institute journal</jtitle><addtitle>Tex Heart Inst J</addtitle><date>2014-04-01</date><risdate>2014</risdate><volume>41</volume><issue>2</issue><spage>203</spage><epage>207</epage><pages>203-207</pages><issn>0730-2347</issn><eissn>1526-6702</eissn><abstract>A 55-year-old woman with a history of complete heart block, atrial flutter, and progressive right ventricular failure was referred to our tertiary care center to be evaluated for cardiac transplantation. The patient's clinical course included worsening right ventricular dysfunction for 3 years before the current evaluation. Our clinical findings raised concerns about arrhythmogenic right ventricular cardiomyopathy. Noninvasive imaging, including a positron emission tomographic scan, did not reveal obvious myocardial pathologic conditions. Given the end-stage nature of the patient's right ventricular failure and her dependence on inotropic agents, she underwent urgent listing and subsequent heart transplantation. Pathologic examination of the explanted heart revealed isolated right ventricular sarcoidosis with replacement fibrosis. Biopsy samples of the cardiac allograft 6 months after transplantation showed no recurrence of sarcoidosis. This atypical presentation of isolated cardiac sarcoidosis posed a considerable diagnostic challenge. In addition to discussing the patient's case, we review the relevant medical literature and discuss the need for updated differential diagnostic criteria for end-stage right ventricular failure that mimics arrhythmogenic right ventricular cardiomyopathy.</abstract><cop>United States</cop><pub>Texas Heart® Institute, Houston</pub><pmid>24808785</pmid><doi>10.14503/THIJ-12-3086</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Texas Heart Institute journal, 2014-04, Vol.41 (2), p.203-207 |
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| source | MEDLINE; PubMed Central; Alma/SFX Local Collection |
| subjects | Arrhythmogenic Right Ventricular Dysplasia - diagnosis Atrial Flutter - etiology Atrioventricular Block - etiology Cardiomyopathies - complications Cardiomyopathies - diagnosis Cardiomyopathies - physiopathology Cardiomyopathies - surgery Cardiotonic Agents - therapeutic use Case Reports Diagnosis, Differential Disease Progression Echocardiography - methods Female Heart Failure - etiology Heart Transplantation - methods Heart Ventricles - pathology Humans Middle Aged Positron-Emission Tomography - methods Sarcoidosis - complications Sarcoidosis - diagnosis Sarcoidosis - physiopathology Sarcoidosis - surgery Treatment Outcome Ventricular Dysfunction, Right - diagnosis Ventricular Dysfunction, Right - etiology Ventricular Dysfunction, Right - physiopathology Ventricular Dysfunction, Right - surgery |
| title | Right ventricular sarcoidosis: is it time for updated diagnostic criteria? |
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