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(Circulation. 2006;114:e635-e637.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

Early Differential Resolution of Right and Left Ventricular Obliteration in Löffler Endocarditis After Chemotherapy and Anticoagulation

Juan Benezet-Mazuecos, MD; Pedro Marcos-Alberca, MD; Jerónimo Farré, MD, PhD, FESC; Miguel Orejas, MD; Adolfo de la Fuente, MD; Elena Prieto, MD

From the Departments of Cardiology (J.B.-M., P.M.-A., J.F., M.O.) and Hematology (A.d.l.F., E.P.), Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.

Correspondence to Juan Benezet-Mazuecos, MD, Department of Cardiology, Fundación Jiménez Díaz, Avenida Reyes Católicos 2, 28040 Madrid, Spain. E-mail jbenezet@yahoo.es

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 27-year-old woman diagnosed of T-cell non-Hodgkin lymphoma was referred to our hospital for allogenic hemopoietic stem cell transplantation. In childhood, the patient was diagnosed with hypereosinophilic syndrome. One week before admission, the patient started to develop progressive dyspnea. On chest x-ray, there were signs consistent with congestive heart failure. Her white cell count was 5990/mm³ with 59% eosinophils. A transthoracic echocardiogram disclosed a complete obliteration of the apexes of both ventricles, which were filled with a mildly echogenic material consistent with fibrosis or thrombosis. The right and left atria were enlarged, and pulsed wave Doppler examination showed a restrictive left ventricular (LV) filling pattern (Figure 1A through 1C). All of these findings were compatible with the diagnosis of Löffler endocarditis. The patient was anticoagulated and received conventional treatment for heart failure, resulting in clinical improvement. One week after admission, chemotherapy with fludarabine and melphalan was started, and a nonmyeloablative transplantation was carried out using hematopoietic progenitors from a human leukocyte antigen–compatible brother. Four weeks after chemotherapy, a repeat echocardiogram showed the total disappearance of the LV obliteration and a normal filling flow (Figure 1D through 1F). The right ventricular (RV) obliteration remained unchanged. The patient was discharged in a stable clinical condition with a total white cell count of 3100/mm³ with eosinophils 1%. Six months later, a repeat echocardiogram showed that the LV cavity remained empty, but the RV apex was still obliterated. Cardiovascular magnetic resonance imaging identified the RV occupation (Figure 2A). . . . [Full Text of this Article]

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Circulation 2006 114: 2571. [Extract] [Full Text]