Kalliath Suneesh, Rajesh Gopalan Nair
Department of Cardiology, Government Medical College, Kozhikode, Kozhikode, Kerala, India.
Heart Asia. 2017 Sep 28;9(2):e010957. doi: 10.1136/heartasia-2017-010957. eCollection 2017.
A 66-year-old man presented with abdominal distension and pedal oedema for the past 10 years. He had history of right heart failure on several occasions in the past, and one of these admissions prompted referral to a cardiac specialist. On examination, he had markedly elevated jugular venous pressure with prominent 'y-descent', a tricuspid regurgitation murmur, gross ascites and pedal oedema. A full blood count, routine biochemical screen and serum bicarbonate levels were normal. Right ventricular angiogram revealed a 'caterpillar'-like aneurysm of the right ventricle (RV) apex (figure 1 arrow) with a dilated right ventricular outflow tract and significant tricuspid regurgitation with a dilated right atrium (see online supplementary video 1). Figure 1 cine angiographic frame of the right ventricle in posteroanterior view, showing a 'caterpillar'-like right ventricle aneurysm (arrow). 10.1136/heartasia-2017-010957.supp3Supplementary file 3.
On the basis of the clinical and right ventriculography features, what is the most likely diagnosis for this patient?Arrhythmogenic right ventricular cardiomyopathy (ARVC)Right ventricular endomyocardial fibrosis (RV-EMF) with an RV aneurysmCardiac sarcoidosisCongenital diverticulum of the right ventricle.
一名66岁男性在过去10年中出现腹胀和足部水肿。他过去曾多次发生右心衰竭，其中一次住院促使他转诊至心脏专科医生处。检查时，他的颈静脉压明显升高，“y降支”突出，有三尖瓣反流杂音，大量腹水和足部水肿。全血细胞计数、常规生化检查和血清碳酸氢盐水平均正常。右心室血管造影显示右心室（RV）心尖部有一个“毛虫”样动脉瘤（图1箭头所示），右心室流出道扩张，三尖瓣反流明显，右心房扩张（见在线补充视频1）。图1 右心室后前位电影血管造影图像，显示一个“毛虫”样右心室动脉瘤（箭头）。10.1136/heartasia-2017-010957.supp3补充文件3。
根据临床和右心室造影特征，该患者最可能的诊断是什么？
致心律失常性右心室心肌病（ARVC）
伴有右心室动脉瘤的右心室心内膜纤维化（RV-EMF）
心脏结节病
右心室先天性憩室
