title: An adult case with an abnormal right ventricular structure causing intraventricular pressure gradient and a history of aphthous stomatitis and thrombophlebitis.
abstract: We report a 50-year-old man with a right ventricular structure causing an intraventricular pressure gradient. He had been diagnosed as vasculo-Behçet with a history of aphthous stomatitis and thrombophlebitis. He had also been suffering from atrial flutter and mild right-side heart failure. Echocardiography showed that there was an abnormal structure attached to the right ventricular free wall and protruding into the cavity, and that it caused the pressure gradient estimated to be approximately 19 mmHg. Chest X-ray computed tomography demonstrated that the structure was partially calcified. Magnetic resonance imaging depicted the structure separating the right ventricle into two chambers. Angiographic study revealed a markedly enlarged right atrium and a filling defect at the mid-portion of the right ventricle, which divided the right ventricular cavity into two parts. Hemodynamic study showed a slightly elevated right atrial pressure (mean 7 mmHg) and a peak-to-peak intraventricular pressure difference of 18 mmHg in the right ventricle. The diastolic pressure tracing of the right ventricular low pressure chamber showed a 'dip and plateau' pattern. Although the pathological features of the abnormal right ventricular structure in this case were not fully clarified, abnormal muscle bundle and/or endocardial fibrosis, which were reported to be associated with Behçet's disease, may have contributed to its generation.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sugishita
authors.forename: S
authors.initials: S
authors.lastname: Tajima
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.forename: K
authors.initials: K
authors.lastname: Sugishita
authors.forename: K
authors.initials: K
authors.lastname: Harada
authors.forename: H
authors.initials: H
authors.lastname: Matsui
authors.forename: M
authors.initials: M
authors.lastname: Inoue
authors.forename: Y
authors.initials: Y
authors.lastname: Murakawa
authors.forename: J
authors.initials: J
authors.lastname: Suzuki
authors.forename: K
authors.initials: K
authors.lastname: Takenaka
authors.forename: M
authors.initials: M
authors.lastname: Omata
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D001282:Atrial Flutter / Q000209:etiology; D001528:Behcet Syndrome / Q000150:complications*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006333:Heart Failure / Q000209:etiology; D006352:Heart Ventricles / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013281:Stomatitis, Aphthous / Q000150:complications*; D013924:Thrombophlebitis / Q000150:complications*; D017725:Ventricular Pressure