Aneurysm of saphenous vein bypass graft detected by first-pass radionuclide ventriculography

Abstract

erythrocytes, megakaryocytes, and heart cells. 4 Thus B19 infection could result in anemia, thrombocytopenia, and myocarditis. B19 DNA has been detected in vitro in myocardial cells. 6 Round cell myocardial infiltrates I and intranuclear viral particles typical of B19 have been seen on light and electron microscopic examination, respectively, of fetal cardiac tissue obtained after death. SaintMartin et al.3 recently reported a 1-year-old child with fatal myocarditis associated with serologic evidence of acute B19 infection. B19 DNA was also detected in postmortem myocardial tissue. Ours is the first report of a newborn with cardiomyopathy associated with documented B19 infection. This case also illustrates the relative insensitivity of the anti-B 19 IgM antibody determination for the serodiagnosis of fetal and neonatal B19 infection. 2 In our case, and in others previously reported, 2 viral DNA, but not anti-B19 IgM antibody, was detected in the neonatal period. Dilated cardiomyopathy may be familial or associated with a number of toxins, nutritional deficiencies, carnitine deficiency, ischemia, Kawasaki syndrome, hyperthyroidism and hypothyroidism, and hypoparathyroidism. 7 These causes were all excluded in our patient. Infectious myocarditis, predominantly ascribed to enteroviruses, is the most common putative cause, although many cases remain unexplained. 7 To our knowledge, however, dilated cardiomyopathy associated with B19 infection has not been previously reported in a live-born infant. We speculate that a spectrum of cardiac abnormalities may be associated with intrauterine B 19 infection, in part determined by viral inoculum, fetal gestational age, and immunocompetence. These disease manifestations in the neonate may include, but are not limited to, self-limited or chronic myocarditis, endocardial fibroelastosis, and congenital cardiomyopathy. The prevalence of B19 infection in myocardial disease awaits further investigation.