Progression of left ventricular apical hypoplasia-like restrictive cardiomyopathy with severe pulmonary hypertension: Follow-up from fetal stage

Abstract

Left ventricular (LV) apical hypoplasia is a rare restrictive cardiomyopathy subtype with an unclear pathophysiology. LV apical hypoplasia typically presents with elongated right ventricle (RV) wrapping around a truncated and spherical LV with a deficient apex (the "banana-shape" of the RV). Here we report a case of a young boy with apparent LV apical hypoplasia that developed after birth; no "banana-shaped" RV was observed during the fetal period. Moreover, suprasystemic pulmonary hypertension (PH) developed even after a mitral valve replacement was performed for progressive mitral stenosis and regurgitation at 14 months of age. He underwent surgery for the Potts shunt, a shunt between the pulmonary artery and aorta, at 13 years to secure systemic output. His PH ameliorated and his heart failure remained stable for 3 years after the operation. This case indicates that the "banana-shaped" RV seen in this condition is not always congenital but that it can form and develop after birth. Furthermore, this case supports the usefulness of the Potts shunt as a therapeutic option in patients with severe PH due to LV apical hypoplasia. <Learning objective: Left ventricular apical hypoplasia typically presents with elongated right ventricle wrapping around a truncated and spherical left ventricle with a deficient apex. However, this characteristic may not be always congenital and can also form and develop after birth. The Potts shunt, a shunt between the pulmonary artery and aorta, may be a therapeutic option in patients with severe pulmonary hypertension due to left ventricular apical hypoplasia.>.

Keywords: Left ventricular apical hypoplasia; Mitral valve replacement; Potts shunt; Pulmonary hypertension; Restrictive cardiomyopathy.