HADİ SASANİ, Memduh DURSUN, AHMET KAYA BİLGE

THE ROLE OF MAGNETIC RESONANCE IMAGING IN DIAGNOSIS OF ARRHYTHMOGENIC RIGHT VENTRICLE DYSPLASIA

Aim: Arrhythmogenic right ventricle dysplasia and cardiomyopathy (ARVD/C) occurs due to fibrofatty tissue infiltration in the ventricle myocardium.. Although the etiology has not been completely understood, it is responsible for the sudden death in early adolescents and athletics. We aimed to demonstrate the accuracy of ARVD/C findings in clinically confirmed ARVD/C cases by cardiac magnetic resonance imaging (MRI). Materials and Methods: Cardiac MRI findings of clinically diagnosed 23 ARVD/C patients (18 male, 5 female; mean age: 38.2; SD: ± 13) were evaluated retrospectively. In four chamber cine images at both end-diastolic and end-systolic phases of cardiac cycle, the endocardial diameters of both atria and ventricles were measured. Results: Findings were found as following: Right ventricular dilation in end-diastolic phase (>42 mm: 78.2%), right atrial dilation (> 41 mm: 78.2%), myocardial fatty replacement (74%) and left ventricular dilation (>42 mm: 74%), ventricle wall motion disorders on Cine MRI (43.5%), decrease in myocardial contractions (30.4%), postcontrast enhancement due to fibrosis (21.7%), right ventricle outflow tract dilation (21.7%), trabeculation (17.4%). Tricuspid insufficiency was 4.3% and Ebstain’s anomaly was found as 4.3%. Conclusion: MRI is useful for the diagnosis of ARVD/C. In the current study, the most frequent MRI findings were right ventricular and atrial dilation, myocardial fatty infiltration and left ventricular dilation respectively. The presence of fibrosis is significant for the diagnosis of ARVD/C. The left ventricle involvement is rare and may occur in ARVD/C.

ARİTMOJENİK SAĞ VENTRİKÜL DİSPLAZİSİ TANISINDA MANYETİK REZONANS GÖRÜNTÜLEMENİN YERİ

Amaç: Aritmojenik sağ ventrikül displazisi ve kardiyomiyopati (ARVD/C) ventrikül miyokardındaki fibröz ve yağ dokusunun infiltrasyonuna bağlı olarak ortaya çıkar. Etiyolojisi tam olarak anlaşılmamış olmasına rağmen, erken ergenlik döneminde ve atletlerdeki ani ölümlerden sorumludur. Klinik olarak onaylanmış ARVD / C vakalarında ARVD / C bulgularının kardiyak manyetik rezonans görüntüleme (MRG) ile hassasiyetini incelemeyi amaçladık Materyal ve Metot: Bu çalışmada, 23 (18 Erkek, 5 Kadın; yaş ortalaması 38.2 SD: ± 13) ARVD tanılı hastanın kardiyak MRG bulguları retrospektif olarak değerlendirildi. Kardiyak siklusun diyastol sonu ve sistol sonu fazlarda dört boşluk (4CH) görüntülerde, atrium ve ventriküllerin endokardiyal çapları ölçüldü. Bulgular: Elde edilen sonuçlar sırasıyla end-diyastolik fazda sağ ventrikül dilatasyonu (42 mm˂ %78.2) ve sağ atrium dilatasyonu (41 mm˂ %78.2) olup, bunu takiben miyokardda yağ infiltrasyonu (%74), sol ventrikül dilatasyonu (42 mm˂ %74), Cine MRG incelemede paradoks hareket ve duvar hareket bozuklukları (%43.5), miyokard kontraksiyonunda azlama (%30.4), postkontrast fibrozis lehine tutulum (%21.7), RVOT dilatasyonu (%21.7), trabekülasyon artışı (%17.4) ve eşlik eden diğer anomaliler (triküspit kapak yetersizliği: %4.3 ve Ebstain anomalisi: %4.3) şeklinde bulundu. Sonuç: Kardiyak MRG, ARVD/C tanı için vazgeçilmez bir görüntüleme modalitesidir. Bu çalışmada en sık MRG bulguları sırasıyla sağ ventrikül ve atriyal dilatasyon, miyokard yağ infiltrasyonu ve sol ventrikül dilatasyonu olarak bulundu. Fibrozis varlığı ARVD/C tanısı için önemlidir. Sol ventrikül tutulumu nadir olup, detaylı bir şekilde değerlendirlimelidir.

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