case_images: PMC5353452_01
case_images: M-mode echocardiogram before surgery, showing severe dilatation of left ventricular dilatation and hypokinesia of the regional wall motion
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case_images: F1
case_images: Complete echocardiographic examination showed [Figure 1] an enlarged left ventricular (LV) end-diastolic diameter (63 mm), a reduced ejection fraction (EF) according to the Simpson's method (EF = 30%), and a two-layer structure with a compacted, thin epicardial band and a much thicker noncompacted endocardial layer of trabecular meshwork with deep endomyocardial spaces.
case_images: Echocardiographic apical long-axis view before surgery, showing noncompacted myocardial layers in the mid-apical portion of the posterior wall, with prominent trabeculae and deep intertrabecular recesses
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case_images: F2
case_images: The predominant localization of the hypertrabeculation was observed in the posterior and antero-lateral areas [Figure 2].
case_images: Color Doppler in apical off-axis view before surgery, showing systo-diastolic supravalvular aortic flow directed towards the right ventricle, referred to as aorto-right ventricular fistula
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case_images: F3
case_images: Echocardiography also revealed a systo-diastolic flow with aliasing within the supravalvular aortic region with a major diastolic component (diastolic gradient 80 mmHg, systolic gradient 45 mmHg) Blood flow was unidirectional [Figure 3] from the aorta to the right heart chamber, as occurs in high-output aorto-right ventricular fistula.
case_images: Magnetic resonance image before surgery, showing prominent left ventricular trabeculation with the typical two-layer structure of the myocardial wall, consisting of a thin compacted epicardial layer and a thick non compacted endocardial layer, located in the mid-apical portion of the posterior and apical walls, confirming the diagnosis of left ventricular noncompaction
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case_images: F4
case_images: Cardiac magnetic resonance (CMR) confirmed LVNC: Increased intraventricular trabeculations of the lateral and posterior wall were evidenced, as well as a thin trabecula network with a two-layer wall structure in the mid and distal ventricular cavity [Figure 4].
case_images: M-mode echocardiogram after surgery, showing normalization of left ventricular dimensions and regional wall motion
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case_images: F5
case_images: Complete echocardiographic examination showed normalization [Figure 5] of LV end-diastolic diameter (54 mm) and EF (62%).
case_images: Echocardiographic apical off-axis view after surgery, showing reduced noncompacted myocardial layers in the mid-apical portion of the inferior-posterior and antero-lateral walls and normalization of left ventricular volume
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case_images: F6
case_images: Furthermore, LV trabeculations were less prominent and no longer met the diagnostic criteria for noncompaction [Figure 6].