Grand Rounds

Bronchiolitis Unveiling a Hidden Heart: A Case of Left Ventricular Non-compaction

Aishwarya Padubidri Muralidhar
Paediatric Cardiac ICU, CARE Hospitals, Banjara Hills, Hyderabad

Address for Correspondence: Aishwarya Padubidri Muralidhar, Paediatric Cardiac ICU, CARE Hospitals, Banjara hills road no 1, Hyderabad. Email: aishu.padubidri.m@gmail.com

Keywords: Bronchiolitis, left ventricular non compaction, pediatric cardiology

Clinical Problem:
An 8-month-old male infant presented with a three-day history of cough, rhinorrhoea, and low-grade fever and one day history of fast breathing and feeding difficulties. He was born full-term with no significant past medical history. Physical examination revealed an irritable child with tachypnoea, tachycardia, subcostal, intercostal retractions, and bilateral wheezes. Oxygen saturation was 92% on room air. Other systemic examinations were normal. Complete blood count was unremarkable. C-reactive protein was mildly elevated. Chest X-ray showed hyperinflation and patchy atelectasis consistent with bronchiolitis. The infant was managed conservatively with supportive care, including supplemental oxygen, nebulized bronchodilators, and adequate hydration. However, despite initial improvement, the child continued to exhibit tachypnoea and tachycardia. Due to the persistent symptoms, a transthoracic echocardiogram was performed which revealed a left ventricle with prominent trabeculations and deep intertrabecular recesses, raising suspicion for Left ventricular non compaction (LVNC). Left ventricular systolic function was reduced with an estimated ejection fraction of 45%.
A detailed cardiac evaluation, including a repeat echocardiogram and electrocardiogram (ECG), was performed. The repeat echocardiogram confirmed the presence of prominent trabeculations and deep intertrabecular recesses in the left ventricle, consistent with LVNC. ECG was unremarkable. Cardiac magnetic resonance imaging (CMR) was performed to further characterize the LVNC and assess for any associated abnormalities. CMR confirmed the diagnosis of LVNC with moderate severity.
On consultation with the paediatric cardiologist, the infant was started on diuretics and an angiotensin-converting enzyme inhibitor to manage heart failure symptoms associated with LVNC to which the child responded well and was discharged on day 7 of admission. The infant is currently asymptomatic and receiving regular cardiology follow-up.
This case highlights the importance of considering underlying cardiac conditions in infants with persistent respiratory symptoms following an episode of bronchiolitis. A comprehensive evaluation, including careful clinical assessment, thorough investigations, and close follow-up, in infants with suspected cardiac involvement can aid in early diagnosis and prompt treatment.

What is left ventricular non compaction?