Case 27

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Case 27

A 64-year-old male with idiopathic dilated cardiomyopathy (angiographically normal coronary arteries) is undergoing cardiac transplant evaluation. He is admitted with severe biventricular failure and treated with aggressive medical management that includes milrinone. An equilibrium radionuclide angiocardiography and dynamic first-pass imaging study were performed to assess his left and right ventricular function.

(Video 1a)

(Video 1b)

(Fig. 1)

On first-pass imaging, RA and RV are enlarged, and RVEF is 19% with suspicion of severe tricuspid incompetence. On multiple gated acquisition (MUGA), LV is massively enlarged with global severe hypokinesia, and LVEF is 11%.

Right heart catheterization during this admission showed: RA pressure = 20 mm Hg, RV = 55/20 mm Hg, PA= 56/26 mm Hg, PCWP = 33 mm Hg, PA Saturation = 41%, C.I = 1.42 L/min/m².

He underwent heart transplant and had an uneventful postoperative recovery.

(Fig. 2)

[/level-membership-for-internal-medicine-category][not-level-membership-for-internal-medicine-category]

Case 27

A 64-year-old male with idiopathic dilated cardiomyopathy (angiographically normal coronary arteries) is undergoing cardiac transplant evaluation. He is admitted with severe biventricular failure and treated with aggressive medical management that includes milrinone. An equilibrium radionuclide angiocardiography and dynamic first-pass imaging study were performed to assess his left and right ventricular function.

[/not-level-membership-for-internal-medicine-category]

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