Abstract
A 69-year-old man with a recent history of aortic valve replacement was hospitalized for paradoxical increasing dyspnea and congestive heart failure. However, echocardiography showed no dysfunction of the prosthetic aortic valve. Planar radionuclide imaging demonstrated intense uptake of Tc-99m pyrophosphate within the myocardium. SPECT revealed biventricular abnormal uptake, mild in the right ventricular free wall and intense in the left ventricular septum and apex, suggesting amyloid deposits. Right heart catheterization found a “dip and plateau” diastolic pressure configuration and histology confirmed amyloidosis on myocardial biopsy. Diagnosis of amyloidosis had not been made by other noninvasive methods: ECG without low QRS voltage, echocardiography showing increased chamber size and concentric hypertrophy, but no infiltrating process in the ventricular walls.
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