Left Ventricular Noncompaction With Multiple Thrombi in Apical Aneurysm

Left ventricular noncompaction (LVNC) is a rare form of cardiomyopathy caused by the failure of myocardial compaction during embryogenesis. Its clinical features are variable ranging from asymptomatic to cardiac dysfunction, heart failure (HF), arrhythmias, and systemic thromboembolism. However, there have been only few reports regarding its coexistence with LV aneurysm. A 44-year-old man with no significant cardiopulmonary history was admitted to our hospital because of heart failure. The chest radiography exhibited pulmonary congestion. The laboratory data was unremarkable except for elevated brain-type natriuretic peptide and troponin T. Transthoracic echocardiography demonstrated global hypokinesis with an ejection fraction of 32%, prominent trabeculation and deep intertrabecular recesses, and apical aneurysm with multiple thrombi (10 × 13 mm in inferior wall, 15 × 8 mm in anteriol wall). Cardiac magnetic resonance imaging showed increased noncompacted (NC) endomyocardial layer depth compared to the compacted (C) epicardial layer (NC/C ratio > 2.3) and thrombi in apical aneurysm. Coronary angiography revealed no significant obstructive stenosis. Pathological analysis demonstrated no evidence of myocarditis, sarcoidosis, amyloidosis or hemochromatosis. Based on these findings, he was diagnosed as LVNC complicated with apical aneurysm. Carvedilol, enalapril, furosemide and warfarin were started to manage HF and prevent stroke or systemic thromboembolism. Four weeks after starting anticoagulation, apical thrombi disappeared without clinical signs of embolism. Here, we report the patient who have LVNC with multiple thrombi in apical aneurysm.