Transcript Case of the week – 06-02 - Society for Cardiovascular

Case of the week – 06-14: Delayed enhancement-targeted biopsy
Clinical: A 53-yr-old ♂ with 2 types of symptomatic VT. One VT with LBBB
and superior axis suggested origin from RV inflow, likely from IVS. Rest ECG
shows inverted T waves inferiorly and no epsilon wave.
EPS: normal coronaries; 3 VT morphologies, one resembling the clinical VT.
CMR: No fatty infiltration on T1W. Normal RV & LV size & function (bright
mid-myocardial signal on short axis SSFP cine is due to prior Gadolinium
injection). Late Gd-imaging (IR-FLASH) shows mid-myocardial enhancement
of the IVS (close to the inflow -arrowheads), anterior RV (arrow) and lateral
LV walls.
Biopsy: Targeted to the enhancing areas: fibro-fatty ARVD type histology.
Perspective: Delayed enhancement on CMR may correspond to the
arrhythmogenic foci. It may help target a biopsy.
CMR system: 1.5 T Magnetom Avanto, Siemens, Germany.
Gurpreet Singh Gulati, Rajnish Juneja, Rakesh Yadav
Ruma Ray, Cardiothoracic Center, All India Institute of
Medical Sciences, Ansari Nagar, New Delhi-110029, India