Cardiac Sarcoidosis Presenting as Mitral Regurgitation

Brian Cross, Jeremy Nicolarsen, James Bullock, Lissa Sugeng, Dianna Bardo, Roberto Lang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Cardiac sarcoidosis is most often clinically silent. When symptomatic, it commonly involves the conduction system. This inflammatory and infiltrative process may be manifest as conduction delays and/or important ventricular ectopy. More diffuse myocardial infiltration may result in congestive heart failure (CHF). This case report illustrates how a more focal infiltrative process in sarcoidosis may cause severe CHF with involvement of the papillary muscle, resulting in worsening of mitral regurgitation. After a cardiac workup that revealed evidence of sarcoidosis, a gadolinium-enhanced magnetic resonance imaging series showed focal infiltration of the left ventricular wall over the region of the posterior papillary muscle, giving a pathophysiologic explanation for the patient's severe mitral regurgitation. This case report depicts sarcoidosis-associated CHF arising in an unusual fashion, resulting not from widespread myocardial infiltration, but rather from focal papillary muscle involvement and, consequently, mitral valve dysfunction. This example suggests that cardiac sarcoidosis should be considered in the differential diagnosis of mitral regurgitation leading to progressive CHF. We briefly review the diagnostic approach to cardiac sarcoidosis, with representative images from this case.

Original languageEnglish (US)
Pages (from-to)906.e9-906.e13
JournalJournal of the American Society of Echocardiography
Volume20
Issue number7
DOIs
StatePublished - Jul 2007
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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