22791498 Visualization

A 51 Age - year Age - old Age man Sex was referred Clinical_event to our hospital Biological_structure due to severe Severity congestive Detailed_description heart Disease_disorder failure Disease_disorder and ventricular Biological_structure arrhythmias Disease_disorder in March Date 2008 Date .
He had been suffering from heart Disease_disorder failure Disease_disorder and ventricular Biological_structure tachycardia Sign_symptom for Duration years Duration despite receiving the conventional Therapeutic_procedure treatment Therapeutic_procedure (ie, furosemide Medication , lisinopril Medication hydrate Medication , pimobendan Medication , warfarin Medication potassium Medication , carvedilol Medication , metildigoxin Medication and amiodarone Medication hydrochloride Medication ).
His height was 161 Height cm Height and body weight was 83 Weight kg Weight .
Blood Diagnostic_procedure pressure Diagnostic_procedure was 110/60 Lab_value mm Lab_value Hg Lab_value .
The fasting Diagnostic_procedure blood Diagnostic_procedure glucose Diagnostic_procedure was 107 Lab_value mg/dl Lab_value and HbA1c Diagnostic_procedure was 6.3% Lab_value .
The chest Biological_structure x Diagnostic_procedure - ray Diagnostic_procedure showed cardiomegaly Sign_symptom with a cardiothoracic Diagnostic_procedure ratio Diagnostic_procedure of 0.67 Lab_value (figure 1A).
ECG Diagnostic_procedure , as shown in video 1, revealed a diffused Detailed_description hypokinetic Sign_symptom left Sign_symptom ventricle Sign_symptom with markedly Lab_value dilated Lab_value left Diagnostic_procedure ventricle Diagnostic_procedure dimension Diagnostic_procedure ( end Diagnostic_procedure - diastole Diagnostic_procedure : 95 Lab_value mm Lab_value ) and reduced Lab_value EF Diagnostic_procedure ( 0.11 Lab_value ).
The coronary Biological_structure angiogram Diagnostic_procedure was normal Lab_value .
A myocardial Biological_structure biopsy Diagnostic_procedure revealed that over Lab_value 50% Lab_value of Lab_value cardiomyocytes Lab_value were replaced by fibrosis Sign_symptom (figure 2).
An implantable Detailed_description cardioverter Therapeutic_procedure - defibrillator Therapeutic_procedure was implanted.
Due to the typical Lab_value facial Diagnostic_procedure appearance Diagnostic_procedure and thickening Sign_symptom of Sign_symptom hands Sign_symptom , he was referred Clinical_event to the endocrinology Nonbiological_location department Nonbiological_location .
The plasma Diagnostic_procedure level Diagnostic_procedure of Diagnostic_procedure GH Diagnostic_procedure was 8.2 Lab_value ng/ml Lab_value and IGF-1 was 504 Lab_value ng/ml Lab_value .
MRI Diagnostic_procedure demonstrated a macroadenoma Disease_disorder in the pituitary Biological_structure .
Thus, he was diagnosed as acromegaly Disease_disorder .
He was treated with octreotide Medication long Detailed_description - acting Detailed_description - release Detailed_description ( LAR Detailed_description ) for 8 Duration months Duration .
Thereafter, he underwent trans Therapeutic_procedure - sphenoidal Therapeutic_procedure surgery Therapeutic_procedure in January Date 2009 Date (figure 3).
The plasma Diagnostic_procedure levels Diagnostic_procedure of Diagnostic_procedure GH Diagnostic_procedure and IGF-1 were decreased Lab_value with octreotide Medication LAR Detailed_description , but basal Diagnostic_procedure plasma Diagnostic_procedure levels Diagnostic_procedure of Diagnostic_procedure GH Diagnostic_procedure were always more Lab_value than Lab_value 4 Lab_value ng/ml Lab_value and plasma Diagnostic_procedure IGF-1 levels Diagnostic_procedure were above Lab_value the Lab_value appropriate Lab_value age Lab_value range Lab_value (figure 3).
After surgery Coreference , both plasma Diagnostic_procedure levels Diagnostic_procedure of Diagnostic_procedure GH Diagnostic_procedure and IGF-1 further Lab_value decreased Lab_value .
Basal Diagnostic_procedure plasma Diagnostic_procedure levels Diagnostic_procedure of Diagnostic_procedure GH Diagnostic_procedure were mostly Lab_value less Lab_value than Lab_value 0.5 Lab_value ng/ml Lab_value and IGF-1 levels were within Lab_value normal Lab_value ranges Lab_value (figure 3).
With the treatment of LAR Coreference , the cardiac Diagnostic_procedure function Diagnostic_procedure improved Lab_value partially Lab_value ( cardiothoracic Diagnostic_procedure ratio=0.58; EF=0.20 in September Date 2008 Date ).
After surgery Coreference , the cardiac Diagnostic_procedure function Diagnostic_procedure improved Lab_value drastically Lab_value ( cardiothoracic Diagnostic_procedure ratio=0.47; EF=0.55 in April Date 2009 Date ; figures 1B and ​and2B).2B).
Frequency Lab_value of ventricular Biological_structure arrhythmias Disease_disorder decreased Lab_value and pimobendan Medication was tapered off.