Ventricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia

doi:10.1016/0002-9149(72)90073-2

The American Journal of Cardiology

Volume 30, Issue 3, August 1972, Pages 282-287

https://doi.org/10.1016/0002-9149(72)90073-2 Get rights and content

Abstract

The case of a 22 year old Negro man with sarcoidosis proved by biopsy to involve lung, liver and myocardium is reported. The electrocardiogram showed typical changes of an anterolateral wall myocardial infarction, and the patient had multiform premature ventricular contractions and episodes of ventricular tachycardia which were unresponsive to treatment with steroids and currently available antiarrhythmic agents. Aneurysm of the left ventricular apex—the size of a tennis ball—was demonstrated by angiocardiography, and surgical resection provided dramatic improvement of the ventricular arrhythmias. This is the third reported case of ventricular aneurysm due to sarcoid, and the first case to be diagnosed clinically and treated successfully by surgical resection at open heart surgery. Ventricular aneurysm, regardless of origin, may present with refractory ventricular tachycardia, which can be successfully treated by surgical excision of the aneurysm.

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Cited by (60)

Cardiac sarcoidosis presenting as arrhythmogenic right ventricular cardiomyopathy/dysplasia with ventricular aneurysms: a case report
2018, Cardiovascular Pathology
Citation Excerpt :
Ventricular aneurysms occur in 10% of the patients, mostly in anterior and septal wall segments. This is associated with poor clinical outcomes [1,13,14]. Another scarce presentation of sarcoidosis is isolated RV sarcoidosis manifesting as RV failure or with life-threatening arrhythmias.
A 70-year old Caucasian man with recurrent ventricular tachycardia and progressive biventricular failure attributed to arrhythmogenic right ventricular cardiomyopathy/dysplasia was evaluated for heart transplantation. Cardiac ventriculography revealed an abnormal left ventricle with five saccular aneurysms. Heart transplantation was performed. Pathology of the explanted heart showed multifocal sarcoid granulomas. Replacement fibrosis was widespread in both ventricles and associated with saccular aneurysms. No genetic basis was identified. Thus, the evidence suggested progressive cardiac sarcoidosis caused this patient's unusual condition.
Management of Cardiac Sarcoidosis
2017, Encyclopedia of Cardiovascular Research and Medicine
Sarcoidosis is a noninfectious granulomatous disorder of unknown cause that affects many organ systems, most often the lungs but not uncommonly the heart. Cardiac sarcoidosis is more prevalent than previously thought and is the second leading cause of sarcoidosis-related mortality following pulmonary complications. In older observational studies, sarcoidosis was thought to be relatively uncommon, affecting the heart in approximately 5% of patients; however, in autopsy studies and in studies using more sophisticated imaging techniques, the prevalence of cardiac involvement was closer to 25%–30%. This variability suggests that the diagnosis of cardiac sarcoidosis is difficult to establish based upon standard clinical criteria and that the methods for disease detection need to be better standardized.
Cardiac sarcoidosis
2009, American Heart Journal
Citation Excerpt :
Thus, patients with end-stage heart failure or intractable arrhythmias should be considered for transplantation and should not be disqualified due to the diagnosis of sarcoidosis. Other surgical interventions have been reported with variable success in CS, such as aneurysm resection and ventricular exclusion of affected myocardium.126-128 Cardiac sarcoidosis is a rare but potentially fatal condition that can mimic more common conditions.
Cardiac sarcoidosis (CS) is a rare but potentially fatal condition that may present with a wide range of clinical manifestations including congestive heart failure, conduction abnormalities, and most notably, sudden death. Recent advances in imaging technology allow easier detection of CS, but the diagnostic guidelines with inclusion of these techniques have yet to be written. It has become clear that minimally symptomatic or asymptomatic cardiac involvement is far more prevalent than previously thought. Because of the potential life-threatening complications and potential benefit of treatment, all patients diagnosed with sarcoidosis should be screened for cardiac involvement. Patients with CS and symptoms such as syncope need an aggressive workup for a potentially life-threatening etiology, and often require implantable cardioverter-defibrillator therapy. CS patients without arrhythmic symptoms are still at risk for sudden death and may warrant an implantable cardioverter-defibrillator for primary prevention reasons. Athough corticosteroids are regarded as the first-line drug of choice, therapy for CS is not yet standardized, and it is unclear at this point whether asymptomatic patients require therapy. Randomized clinical trials are clearly warranted to answer these very important patient care questions, and are endorsed fully by the authors.
Sarcoid heart disease: Clinical course and treatment
2004, International Journal of Cardiology
Sarcoidosis is a rare granulomatous disease of unknown etiology that can affect any organ. Cardiac involvement, although uncommon, has a wide spectrum of clinical manifestations and is potentially fatal. Although there is no agreement upon a strategy for the diagnosis (which is difficult to make based on clinical information alone), the introduction of newer technology is promising and may be useful both for the early diagnosis of cardiac involvement and for the evaluation of response to therapy.
Early treatment is crucial in improving symptoms and prognosis. ICD implantation and cardiac transplantation may offer improvements in management, as steroid therapy and pacemaker implantation has led to improved outcomes over the past three decades.
Diagnosis of cardiac sarcoidosis and evaluation of the effects of steroid therapy by gadolinium-DTPA-enhanced magnetic resonance imaging
2001, The American journal of medicine
Citation Excerpt :
Electrocardiographic changes are found in as many as 50% of patients with systemic sarcoidosis without clinical evidence of cardiac involvement (12–14); the most common findings are repolarization changes, arrhythmias, and conduction disturbances (11). Evidence of transmural infarction is less common (15,16). Echocardiography can detect features such as septal thinning, left ventricular regional systolic dysfunction, pericardial effusion, and left ventricular diastolic dysfunction in advanced cardiac sarcoidosis (17–21).
BACKGROUND: Cardiac involvement is an important prognostic factor in patients with sarcoidosis. In this study, we evaluated the usefulness of gadolinium-DTPA (diethylene triamine pentaacetic acid)–enhanced magnetic resonance imaging (Gd-MRI) for diagnosing cardiac sarcoidosis and evaluating the effects of steroid therapy.
METHODS: Sixteen patients with sarcoidosis diagnosed by histology or by Japanese Ministry of Health and Welfare criteria for cardiac sarcoidosis underwent Gd-MRI with a 1.5-Tesla superconducting magnet system using a T1-weighted spin-echo sequence.
RESULTS: Gd-MRI showed localized enhancement of signal intensity, indicating interstitial edema, in the left ventricle in 8 of the 16 patients. Two patients with enhancement also had thinning of the left ventricular septal wall. After 1 month of prednisolone therapy (60 mg every other day or 30 to 40 mg every day), the localized high-intensity signals were markedly diminished in all 8 patients.
CONCLUSIONS: Images of the heart obtained by Gd-MRI may reflect active inflammation with interstitial edema in patients with sarcoidosis. Gd-MRI may be a useful noninvasive method for early detection of cardiac sarcoidosis and for evaluating the effects of steroid therapy.
Clinical and electrophysiologic features of idiopathic left ventricular aneurysm with sustained ventricular tachycardia
1998, International Journal of Cardiology
We examined 10 patients with idiopathic left ventricular (LV) aneurysm with sustained ventricular tachycardia (VT) (Id-An group), and compared them with those in 16 age- and sex-matched patients who had postinfarction aneurysm and VT (MI-An group) to clarify detailed clinical and electrophysiologic characteristics of idiopathic LV aneurysm. The clinical and laboratory data and results of electrocardiography, electrophysiologic, and morphologic examinations in the two groups were compared. In the Id-An group, the LV aneurysms were located more often at the posterior and/or inferior wall, while in the MI-An group, they were more often located at the anterior and/or apical wall (P<0.001). The LV end-diastolic volume index was significantly smaller and the LV ejection fraction was significantly higher in the Id-An group (P<0.001). The size of the aneurysm and the area with abnormal electrograms in the Id-An group were significantly smaller than those in the MI-An group (P<0.005 and P<0.001, respectively). The inducibility of VT was high in both groups, and ventricular pacing during VT showed entrainment phenomenon in most of the patients. Thus, in both groups, the abnormal electrograms were closely associated with the wall motion abnormality, and reentry was suggested as the mechanism of VT. In the Id-An group, since the lesions were anatomically and electrophysiologically confined to the posterior and/or inferior wall, the global LV function was more well preserved compared with the MI-An group.

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Case reportVentricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia

Abstract

Dis Chest

Amer Heart J

Amer J Med

Boeck's sarcoid. A report of a case with visceral involvement

Arch Intern Med (Chicago)

Manifestations of sarcoidosis. Analysis of 145 patients, with a review of nine series selected from the literature

Amer J Med

Sarcoid heart disease

New Eng J Med

Recurrent pericardial effusion secondary to sarcoidosis of the pericardium

New Eng J Med

Uber Riesenzellengranulome bei zwei Fällen von Endocardfibrose

Beitr Path Anat

Intractable heart failure with long standing granulomatous disease

Sarcoidosis of the heart associated with myocarditis: report of a case

Illinois Med J

Case report
Ventricular aneurysm due to cardiac sarcoidosis with surgical cure of refractory ventricular tachycardia