Concomitant myocardial injury and valvular disease in Sneddon syndrome: a case report

Figures

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  Figure 1. Twelve-lead electrocardiogram showing a normal sinus and regular rhythm, with sequelae of necrosis in the apicolateral territory.

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  Figure 2. (A) Transthoracic echocardiography showing combined moderate aortic valve stenosis (valve area 1.58 cm2 and 0.89 cm2/m2, mean gradient 22 mmHg, Vmax 2.94 m/s) and a moderate-to-severe aortic insufficiency (vena contracta 8 mm, diastolic flow reversal in the descending aorta 0.19 m/s). (B) Transthoracic echocardiography showing an improvement at 7 years of follow-up: aortic insufficiency was less important than on the initial echocardiography (vena contracta from 8 to 4 mm and diastolic flow reversal in the descending aorta from 0.19 to 0.13 m/s), the aortic stenosis is still moderate (valve area 1.35 cm2 and 0.77 cm2/m2, mean gradient 29 mmHg, Vmax 2.61 m/s).

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  Figure 3. (A) Coronary angiography demonstrating a thin left anterior descending artery with no occlusion. (B and C) Cardiovascular magnetic resonance imaging: delayed gadolinium enhancement sequences showing an apical transmural necrosis in hypersignal (B: long-axis view, C: midventricle short-axis slice).

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  Figure 4. A positron emission tomographic scan performed during the acute phase revealing no argument in favour of vasculitis or infective endocarditis.

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