0:01

This next case is an example of focal left ventricular noncompaction.

0:05

So left ventricular noncompaction is most

0:07

often seen like the previous case, where you have a dilated left ventricle,

0:12

somebody who has a dilated cardiomyopathy in general.

0:16

And the whole of the left ventricle is

0:19

showing areas of hypertrabeculation compared with noncompaction.

0:24

Sometimes, though,

0:25

you encounter a more focal process of left ventricular noncompaction.

0:29

I've seen it not infrequently in patients

0:32

with congenital heart disease, you can see areas of the left ventricle

0:36

which didn't seem to form normally and those seem to be less extensive

0:42

and are often associated with other congenital defects.

0:45

This patient actually, interesting, was a 57-year-old patient with a mixed

0:49

picture of left ventricular noncompaction and hypertrophic cardiomyopathy.

0:52

And what we saw on this particular patient was that they had this whole area

0:56

in the lateral wall of the left ventricle here from mid cavity to base,

1:00

where you see all this sort of disorganized appearance of the lateral

1:04

wall with relatively normal contraction but lots and lots of trabeculation.

1:10

So this is an alternative pattern

1:12

of noncompaction I've seen where you have relatively preserved function but a sort

1:17

of disorganized appearance to the left ventricular wall.

1:20

When we look on the short-axis cine

1:22

images, we see a similar kind of appearance where you have kind

1:25

of a regular disorganized appearance to the wall.

1:28

The compacted part of the myocardium is certainly very thin.

1:32

If you look here on the static images,

1:35

the compacted part of the myocardium is just paper thin right here.

1:39

And then if you were to actually measure the ratio of compacted myocardium

1:44

to normal myocardium, you'd probably end up with something like this.

1:48

This is your compacted myocardium

1:49

and your noncompacted myocardium probably extends out to here.

1:53

So some sort of ratio like this to this,

1:56

which would certainly give you a ratio greater than 2.3. I think you would see

2:00

the more than two segments of involvement because this case does involve both

2:04

the basal segments here and the mid cavity segments in the lateral wall.

2:09

It's an unusual pattern and a little different from what we saw on the previous

2:13

case, which is the more typical appearance.

2:15

So I just wanted to show this as

2:16

an example of a variant of noncompaction that you could encounter.

2:21

On delayed enhancement or late gadolinium enhancement,

2:24

this patient actually happened to have

2:25

some late enhancement in the region of noncompaction, which again can occur

2:31

here in the subendocardial region and then several foci within the trabeculations

2:35

themselves. Can occur, but again is non specific

2:38

and doesn't necessarily really help you with making that diagnosis.

2:42

So this is an example of a patient, an older patient with combined left

2:47

ventricular noncompaction and hypertrophic cardiomyopathy.

2:50

And the left ventricular noncompaction is in this focal pattern where you have areas

2:55

of sort of a disorganized left ventricular wall with thin compacted myocardium.