Reversible dilated cardiomyopathy after lobectomy for pulmonary sequestration

Abstract

ruled out. The patient was not taking any cardiotoxic drug. She was given a diagnosis of idiopathic dilated cardiomyopathy. Oral diuretic and vasodilator treatment was given, and follow-up was recommended. Seven years later, she was admitted for increased shortness of breath and productive cough. Spirometric analysis performed in the pneumology service showed a mild air flow limitation. Allergic skin test responses were negative. A control echocardiogram did not show significant changes in the Pulmonary sequestration is a congenital malformation characterized by a pulmonary lobe or pulmonary segment that receives blood supply directly from the aorta. Classically, 2 forms are described. The first is intralobar sequestration, in which the anomalous lung tissue is contained within the visceral pleura. The blood supply comes directly from the aorta, and normal venous drainage through the pulmonary veins goes to the left atrium. The second form is extralobar sequestration, in which the abnormal lung tissue is separated from the normal lung by its own visceral pleural investment. The blood supply generally derives either from the abdominal aorta or the pulmonary artery, and the venous drainage is through the azygos vein or portal system.1 The relevance of this pathologic condition derives from the difficulty in diagnosis and the risk of development of severe pulmonary and cardiovascular complications. Heart failure usually appears during the neonatal period or childhood and in most patients is associated with congenital cardiac defects.2,3 We report the case of an adult patient without structural cardiac abnormalities in whom a dilated cardiomyopathy caused by an intralobar pulmonary sequestration undiagnosed for many years reverted after lobectomy. Clinical summary. A 30-year-old woman with no pathologic antecedents was seen in our center for increasing shortness of breath of 3 years’ duration. Physical examination revealed a systolic ejection murmur. Results of pulmonary auscultation, electrocardiography, and chest x-ray films were normal. An echocardiogram showed dilatation of the left ventricle and a mild reduction of the left ventricular ejection fraction (Table I). No regurgitations or blood flow accelerations were detected with Doppler ultrasonography. Biochemical and immunologic blood test results were within normal limits. Systemic diseases were REVERSIBLE DILATED CARDIOMYOPATHY AFTER LOBECTOMY FOR PULMONARY SEQUESTRATION