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Number 07-04. Delayed enhancement-targeted biopsy

Case from: Gurpreet Singh Gulati, Rajnish Juneja, Rakesh Yadav, Ruma Ray. Cardiothoracic Center, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India.

Clinical: A 53-yr-old male with 2 types of symptomatic VT. One VT with LBBB and superior axis suggested origin from RV inflow, likely from IVS. Rest ECG shows inverted T waves inferiorly and no epsilon wave.

EPS: normal coronaries; 3 VT morphologies, one resembling the clinical VT.

CMR: No fatty infiltration on T1W. Normal RV & LV size & function (bright mid-myocardial signal on short axis SSFP cine is due to prior Gadolinium injection). Late Gd-imaging (IR-FLASH) shows mid-myocardial enhancement of the IVS (close to the inflow -arrowheads), anterior RV (arrow) and lateral LV walls.

Biopsy: Targeted to the enhancing areas: fibro-fatty ARVD type histology.

Perspective: Delayed enhancement on CMR may correspond to the arrhythmogenic foci. It may help target a biopsy.

CMR system: 1.5 T Magnetom Avanto, Siemens, Germany.

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