Onion-like masses in the left ventricle.

Van der Hulst et al. 9 used three-dimensional echocardiography in post-operative TOF patients. They could show that the RV apex was the most significantly remodelled part of the RV; however, the local ejection fraction was preserved. A significant reduction in the regional RV apical function was also described in patients with pulmonary arterial hypertension and after atrial septal defect closure. 10,11 Together, these data show that more research on regional RV function is required to better understand how the RV adjusts to maintain cardiac output in different disease conditions. The relationship between regional RV remodelling and the RV regional myocardial function could be essential for identifying the early RV dysfunction and failure, and its quantification should help in therapeutic decision-making and prognostication.tional modelling of the right ventricle in repaired Tetralogy of Fallot: can it provide insight into patient treatment? Eur Heart J Cardiovasc Imaging 2012 doi 10.1093/ ehjci/jes239 [epub ahead of print]. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot.dimensional analysis of right ventricular shape and function in pulmonary hyper-tension. et al. Real-time three-dimensional echocardiography: segmental analysis of the right ven-tricle in patients with repaired tetralogy of fallot. right ventricular deformation in patients with open and closed atrial septal defect. A 50-year-old male presented at the emergency department with a hypoglycaemia due to liver failure. One year earlier he was diagnosed with a severe dilated cardiomyopathy related to alcohol and cocaine abuse. Because of otherwise unexplained hypoxia, a CT-scan was performed, which confirmed the diagnosis of pulmonary em-bolism. By serendipity, a large mass was observed in the left ventricle (Panel 1A). Transthoracal echocardiography confirmed mobile masses in the apex and centre of the left ventricle (Panel 1B). No flow was detectable in these masses, consistent with thrombi. Despite the start of anti-coagulant treatment, the patient's condition deteriorated and he died due to liver and heart failure. Post-mortem examination (Panel 1C and D) showed an enlarged heart with multiple biventri-cular thrombi and one large trombus (6 × 1 × 1.5 cm) in the left ventricle. The large thrombus showed an onion-like layering, suggesting a slow formation, resulting from the decreased flow related to cardiomyopathy.