Left ventricular non - compaction: contemporary view of genetic background, clinical course, diagnostic and treatment


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Abstract

This review highlights and discusses recent advances in understanding left ventricular non - compaction (LVNC). Clinical profile, prognosis and even diagnosis are still a great challenge faced by the world. The population prevalence of left ventricular non - compaction remains unknown. High variability of clinical manifestations, genetic heterogenity with overlap of different phenotypes, variability of hereditary patterns suggests that LVNC seems to be rather an isolated trait or a part of phenotypic expression of different cardiac diseases or complex genetic syndromes.

About the authors

A A Streltsova

Almazov Federal Medical Research Centre

Санкт-Петербург, Россия

A Ya Gudkova

Almazov Federal Medical Research Centre; Pavlov First St. Petersburg State Medical University

Санкт-Петербург, Россия

A A Kostareva

Almazov Federal Medical Research Centre; Pavlov First St. Petersburg State Medical University

Санкт-Петербург, Россия

References

  1. Chang B, Nishizawa T, Furutani M, Fujiki A, Tani M, Kawaguchi M, Ibuki K, Hirono K, Taneichi H, Uese K, Onuma Y, Bowles N.E, Ichida F, Inoue H, Matsuoka R, Miyawaki T; Noncompaction study collaborators. Identification of a novel TPM1 mutation in a family with left ventricular noncompaction and sudden death. Mol Genet Metabol. 2011;102(2):200-6. doi: 10.1016/j.ymgme.2010.09.009
  2. Pignatelli R.H, Mc Mahon C.J, Dreyer W.J, Denfield S.W, Price J, Belmont J.W, Craigen W.J, Wu J, El Said H, Bezold L.I, Clunie S, Fernbach S, Bowles N.E, Towbin J.A. Clinical characterization of left ventricular noncompaction in children: a relatively common form of cardiomyopathy. Circulation. 2003;108(21):2672-8. doi: 10.1161/01. CIR.0000100664.10777.B8
  3. Chen R, Tsuji T, Ichida F, Bowles K.R, Yu X, Watanabe S, Hirono K, Tsubata S, Hamamichi Y, Ohta J, Imai Y, Bowles N.E, Miyawaki T, Towbin J.A; Noncompaction study collaborators. Mutation analysis of the G4.5 gene in patients with isolated left ventricular noncompaction. Mol Genet Metabol. 2002;77(4):319-25. doi: 10.1016/S1096-7192(02)00195-6
  4. Bleyl S.B, Mumford B.R, Thompson V, Carey J.C, Pysher T.J, Chin T.K, Ward K. Neonatal, lethal noncompaction of the left ventricular myocardium is allelic with Barth syndrome. Am J Hum Genet. 1997;61(4):868-72. doi: 10.1086/514879
  5. Mageshkumar S, Patil D, Samuel D, Muthukumar D. Unusual case of isolated biventricular non - compaction presenting with stroke. J Postgrad Med. 2011;57(3):211-3. doi: 10.4103/0022-3859.85209
  6. Cohen P.J, Prahlow J.A. Sudden death due to biventricular non - compactioncardiomyopathy in a 14-year - old. Foren Sci Med Pathol. 2015;11(1):92-8. doi: 10.1007/s12024-014-9637-5
  7. Said S, Cooper C.J, Quevedo K, Rodriguez E, Hernandez G.T. Biventricular non - compaction with predominant right ventricular involvement, reduced left ventricular systolic and diastolic function, and pulmonary hypertension in a Hispanic male. Am J Case Rep. 2013;14:539-42. doi: 10.12659/AJCR.889676
  8. Ciurzynski M, Lichodziejewska B, Tomaszewski A, Piotrowska-Kownacka D, Kownacki L, Rymarczyk Z, Wysokinski A, Pruszczyk P. Bi - ventricular noncompaction associated with left ventricular systolic and diastolic dysfunction and severe pulmonary hypertension in a young man. Circ J. 2009;73(11):2163-5. doi: 10.1253/circj.CJ-08-0857
  9. Lahmiti S, Aboussad A. Isolated non - compaction of the right ventricular myocardium: two cases report. Ann Cardiol d’Angeiol. 2012;61(4):299-302. doi: 10.1016/j.ancard.2010.12.001
  10. Stöllberger С, Gerecke B, Finsterer J, Engberding R. Refinement of echocardiographic criteria for left ventricular noncompaction. Int J Cardiol. 2013;165(3):463-7. doi: 10.1016/j.ijcard.2011.08.845
  11. Ichida F, Hamamichi Y, Miyawaki T, Ono Y, Kamiya T, Akagi T, Hamada H, Hirose O, Isobe T, Yamada K, Kurotobi S, Mito H, Miyake T, Murakami Y, Nishi T, Shinohara M, Seguchi M, Tashiro S, Tomimatsu H. Clinical features of isolated noncompaction of the ventricular myocardium: long - term clinical course, hemodynamic properties, and genetic background. J Am Coll Cardiol. 1999;34(1):233-40. doi: 10.1016/S0735-1097(99)00170-9
  12. Nugent A.W, Daubeney P.F, Chondros P, Carlin J.B, Cheung M, Wilkinson L.C, Davis A.M, Kahler S.G, Chow C.W, Wilkinson J.L, Weintraub R.G. The epidemiology of childhood cardiomyopathy in Australia. New Engl J Med. 2003;348(17):1639-46. doi: 10.1056/ NEJMoa021737
  13. Lilje C, Rázek V, Joyce J.J, Rau T, Finckh B.F, Weiss F, Habermann C.R, Rice J.C, Weil J. Complications of non - compaction of the left ventricular myocardium in a paediatric population: a prospective study. Eur Heart J. 2006;27(15):1855-60. doi: 10.1093/eurheartj/ehl112
  14. Jefferies J.L, Wilkinson J.D, Sleeper L.A, Colan S.D, Lu M, Pahl E, Kantor P.F, Everitt M.D, Webber S.A, Kaufman B.D, Lamour J.M, Canter C.E, Hsu D.T, Addonizio L.J, Lipshultz S.E, Towbin J.A; Pediatric Cardiomyopathy Registry Investigators. Cardiomyopathy Phenotypes and Out - comes for Children With Left Ventricular Myocardial Noncompaction: Results From the Pediatric Cardiomyopathy Registry. J Card Fail. 2015;21(11):877-84. doi: 10.1016/j.cardfail.2015.06.381
  15. Oechslin E.N, Attenhofer Jost C.H, Rojas J.R, Kaufmann P.A, Jenni R. Long - term follow - up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cadiol. 2000;36(2):493-500. doi: 10.1016/S0735-1097(00)00755-5
  16. Aras D, Tufekcioglu O, Ergun K, Ozeke O, Yildiz A, Topaloglu S, Deveci B, Sahin O, Kisacik H.L, Korkmaz S. Clinical features of isolated ventricular nonompaction in adults long - term clinical course, echocardiographic properties, and predictors of left ventricular failure. J Cardiac Failure. 2006;12(9):726-33. doi: 10.1016/j.cardfail.2006.08.002
  17. Alston C.L, Ceccatelli Berti C, Blakely E.L, Oláhová M, He L, Mc Mahon C.J, Olpin S.E, Hargreaves I.P, Nolli C, Mc Farland R, Goffrini P, O'Sullivan M.J, Taylor R.W. A recessive homozygous p.Asp92Gly SDHD mutation causes prenatal cardiomyopathy and a severe mitochondrial complex II deficiency. Hum Genet. 2015;134(8):869-79. doi: 10.1007/s00439-015-1568-z
  18. Dhar R, Reardon W, Mc Mahon C.J. Biventricular non - compaction hypertrophic cardiomyopathy in association with congenital complete heart block and type I mitochondrial complex deficiency. Cardiol Young. 2015;25(5):1019-21. doi: 10.1017/S1047951114001279
  19. Sato Y, Matsumoto N, Matsuo S, Yoda S, Iida K, Kunimasa T, Kunimoto S, Saito S. Isolated noncompaction of the ventricular myocardium in a 94-year - old patient: depiction at echocardiography and magnetic resonance imaging. Int J Cardiol. 2007;119(1):e32-34. doi: 10.1016/ j. ijcard.2007.01.101
  20. Ritter M, Oechslin E, Sütsch G, Attenhofer C, Schneider J, Jenni R. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc. 1997;72(1):26-31. doi: 10.4065/72.1.26
  21. Maron B.J, Towbin J.A, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss A.J, Seidman C.E, Young J.B; American Heart Association; Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807-16. doi: 10.1161/CIRCULATION-AHA.106.174287
  22. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P, Dubourg O, Kühl U, Maisch B, Mc Kenna W.J, Monserrat L, Pankuweit S, Rapezzi C, Seferovic P, Tavazzi L, Keren A. Classification of the cadiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29(2):270-6. doi: 10.1093/eurheartj/ehm342
  23. Ильинский И.М., Можейко Н.П., Шевченко А.О. Некомпактная кардиомиопатия. Вестник трансплантологии и искусственных органов. 2016;18(4);146-56. doi: 10.15825/ 1995-1191-2016-4-146-156
  24. Мершина Е.А., Мясников Р.П., Куликова О.В., Харлап М.С., Корецкий С.Н., Ларина О.М., Синицын В.Е., Бойцов С.А. Некомпактная кардиомиопатия левого желудочка: особенности клинического течения и возможности диагностики. Рациональная фармакотерапия в кардиологии. 2015;11(6):638-42. doi: 10.20996/1819-6446-2015-11- 6-638-642
  25. Sedaghat-Hamedani F, Haas J, Zhu F, Geier C, Kayvanpour E, Liss M, Lai A, Frese K, Pribe-Wolferts R, Amr A, Li D.T, Samani O.S, Carstensen A, Bordalo D.M, Müller M, Fischer C, Shao J, Wang J, Nie M, Yuan L, Haßfeld S, Schwartz C, Zhou M, Zhou Z, Shu Y, Wang M, Huang K, Zeng Q, Cheng L, Fehlmann T, Ehlermann P, Keller A, Dieterich C, Streckfuß-Bömeke K, Liao Y, Gotthardt M, Katus H.A, Meder B. Clinical genetics and outcome of left ventricular non - compaction cardiomyopathy. Eur Heart J. 2017 Dec 7;38(46):3449-60. doi: 10.1093/eurheartj/ehx545
  26. Arbustini E, Narula N, Dec G.W, Reddy K.S, Greenberg B, Kushwaha S, Marwick T, Pinney S, Bellazzi R, Favalli V, Kramer C, Roberts R, Zoghbi W.A, Bonow R, Tavazzi L, Fuster V, Narula J. The MOGE(S) classification for a phenotype - genotype nomenclature of cardiomyopathy: endorsed by the World Heart Federation. J Am Coll Cardiol. 2013;62(22):2046-72. doi: 10.1016/j.jacc.2013.08.1644
  27. Kenton A.B, Sanchez X, Coveler K.J, Makar K.A, Jimenez S, Ichida F, Murphy R.T, Elliott P.M, Mc Kenna W, Bowles N.E, Towbin J.A, Bowles K.R. Isolated left ventricular noncompaction is rarely caused by mutations in G4.5, alpha - dystrobrevin and FK binding protein-12. Mol Genet Metabol. 2004;82(2):162-6. doi: 10.1016/j.ymgme.2004.02.009
  28. Vatta M, Mohapatra B, Jimenez S, Sanchez X, Faulkner G, Perles Z, Sinagra G, Lin J.H, Vu T.M, Zhou Q, Bowles K.R, Di Lenarda A, Schimmenti L, Fox M, Chrisco M.A, Murphy R.T, Mc Kenna W, Elliott P, Bowles N.E, Chen J, Valle G, Towbin J.A. Mutations in Cypher/ZASP in patients with dilated cardiomyopathy and left ventricular non - compaction. J Am Coll Cardiol. 2003;42(11):2014-27. doi: 10.1016/j. jacc.2003.10.021
  29. Luedde М, Ehlermann P, Weichenhan D, Will R, Zeller R, Rupp S, Müller A, Steen H, Ivandic B.T, Ulmer H.E, Kern M, Katus H.A, Frey N. Severe familial left ventricular non - compaction cardiomyopathy due to a novel troponin T (TNNT2) Mutation. Cardiovasc Res. 2010;86(3):452-60. doi: 10.1093/cvr/cvq009
  30. Bagnall R.D, Molloy L.K, Kalman J.M, Semsarian C. Exome sequencing identifies a mutation in the ACTN2 gene in a family with idiopathic ventricular fibrillation, left ventricular noncompaction, and sudden death. BMC Med Genet. 2014;15:99. doi: 10.1186/s12881-014-0099-0
  31. Oechslin E, Jenni R. Left ventricular non - compaction revisited: a distinct phenotype with genetic heterogeneity? Eur Heart J. 2011;32(12):1446-56. doi: 10.1093/eurheartj/ehq508
  32. Ohno S, Omura M, Kawamura M, Kimura H, Itoh H, Makiyama T, Ushinohama H, Makita N, Horie M. Exon 3 deletion of RYR2 encoding cardiac ryanodine receptor is associated with left ventricular non - compaction. EP Europace. 2014;16(11):1646-54. doi: 10.1093/europace/eut382
  33. Arbustini E, Favalli V, Narula N, Serio A, Grasso M. Left Ventricular Noncompaction: A Distinct Genetic Cardiomyopathy? J Am Coll Cardiol. 2016;68(9):949-66. doi: 10.1016/j.jacc.2016.05.096
  34. Espinola-Zavaleta N, Soto M.E, Castellanos L.M, Játiva-Chávez S, Keirns C. Non - compacted cardiomyopathy: clinical - echocardiographic study. Cardiovasc Ultrasound. 2006;4:35. doi: 10.1186/1476-7120-4-35
  35. Stöllberger C, Finsterer J. Pitfalls in the diagnosis of left ventricular hypertrabeculation/non - compaction. Postgrad Med J. 2006;82(972):679-83. doi: 10.1136/pgmj.2006.046169
  36. Благова О.В., Недоступ А.В., Седов В.П., Гагарина Н.В., Коган Е.А., Сулимов В.А., Фролова Ю.В., Дземешкевич С.Л., Заклязьминская Е.В., Мершина Е.А., Синицын В.Е., Куприянова А.Г., Зайденов В.А., Донников А.Е. Некомпактный миокард как первичный феномен или следствие дисфункции миокарда: клинические маски синдрома. Кардиология. 2012;52(11):17-26.
  37. Hoedemaekers Y.M, Caliskan K, Majoor-Krakauer D, Van de Laar I, Michels M, Witsenburg M, ten Cate F.J, Simoons M.L, Dooijes D. Cardiac beta - myosin heavy chain defects in two families with non - compaction cardiomyopathy: linking non - compaction to hypertrophic, restrictive, and dilated cardiomyopathies. Eur Heart J. 2007;28(22):2732-7. doi: 10.1093/eurheartj/ehm429
  38. Goud A, Padmanabhan S. A rare form of cardiomyopathy: left ventricular non - compaction cardiomyopathy. J Commun Hosp Intern Med Perspect. 2016;6(1):29888. doi: 10.3402/jchimp.v6.29888
  39. Klaassen S, Probst S, Oechslin E, Gerull B, Krings G, Schuler P, Greutmann M, Hürlimann D, Yegitbasi M, Pons L, Gramlich M, Drenckhahn J.D, Heuser A, Berger F, Jenni R, Thierfelder L. Mutations in sarcomere protein genes in left ventricular noncompaction. Circulation. 2008;117(22):2893-901. doi: 10.1161/CIRCULATION-AHA.107.746164
  40. Lixue Yin. Non-Compact Cardiomyopathy or Ventricular Non-Compact Syndrome? J Cardiovasc Ultrasound. 2014;22(4):165-72. doi: 10.4250/jcu.2014.22.4.165
  41. Murphy R.T, Thaman R, Blanes J.G, Ward D, Sevdalis E, Papra E, Kiotsekoglou A, Tome M.T, Pellerin D, Mc Kenna W.J, Elliott P.M. Natural history and familial characteristics of isolated left ventricular non - compaction. Eur Heart J. 2005;26(2):187-92. doi: 10.1093/eurheartj/ehi025
  42. Miyake C.Y, Kim J.J. Arrhythmias in left ventricular noncompaction. Card Electrophysiol Clin. 2015;7(2):319-30. doi: 10.1016/j. ccep.2015.03.007
  43. Asfalou I, Boulaamayl S, Raissouni M, Mouine N, Sabry M, Kheyi J, Doghmi N, Benyass A. Left ventricular noncompaction - A rare form of cardiomyopathy: Revelation modes and predictors of mortality in adults through 23 cases. J Saudi Heart Assoc. 2017;29(2):102-9. doi: 10.1016/j.jsha.2016.02.004
  44. Lofiego C, Biagini E, Pasquale F, Ferlito M, Rocchi G, Perugini E, Bacchi-Reggiani L, Boriani G, Leone O, Caliskan K, ten Cate F.J, Picchio F.M, Branzi A, Rapezzi C. Wide spectrum of presentation and variable outcomes of isolated left ventricular non - compaction. Heart. 2007;93:65-71. doi: 10.1136/hrt.2006.088229
  45. Sarma R.J, Chana A, Elkayam U. Left ventricular noncompaction. Progr Cardiovasc Dis. 2010;52(4):264-73. doi: 10.1016/j.pcad.2009.11.001
  46. Paterick T.E, Tajik A.J. Left Ventricular Noncompaction - A Diagnostically Challenging Cardiomyopathy. Circ J. 2012;76(7):1556-62. doi: 10.1253/circj.CJ-12-0666
  47. Ikeda U, Minamisawa M, Koyama J. Isolated left ventricular non - compaction cardiomyopathy in adults. J Cardiol. 2015;65(2):91-7. doi: 10.1016/j.jjcc.2014.10.005
  48. Tian T, Liu Y, Gao L, Wang J, Sun K, Zou Y, Wang L, Zhang L, Li Y, Xiao Y, Song L, Zhou X. Isolated left ventricular noncompaction: clinical profile and prognosis in 106 adult patients. Heart Vessels. 2014;29(5):645-52. doi: 10.1007/s00380-013-0409-z
  49. Stanton C, Bruce C, Connolly H, Brady P, Syed I, Hodge D, Asirvatham S, Friedman P. Isolated left ventricular noncompaction syndrome. Am J Cardiol. 2009;104(8):1135-8. doi: 10.1016/j.amjcard.2009.05.062
  50. Jenni R, Oechslin E, Schneider J, Attenhofer Jost C, Kaufmann P.A. Echocardiographic and pathoanatomical characteristics of isolated left ventricular noncompaction: a step towards classification as a distinct cardiomyopathy. Heart. 2001;86(6):666-71. doi: 10.1136/heart.86.6.666
  51. Petersen S.E, Selvanayagam J.B, Wiesmann F, Robson M.D, Francis J.M, Anderson R.H, Watkins H, Neubauer S. Left ventricular non - compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2005;46(1):101-5. doi: 10.1016/j.jacc.2005.03.045
  52. Jacquier A, Thuny F, Jop B, Giorgi R, Cohen F, Gaubert J.Y, Vidal V, Bartoli J.M, Habib G, Moulin G. Measurement of trabeculated left ventricular mass using cardiac magnetic resonance imaging in the diagnosis of left ventricular non - compaction. Eur Heart J. 2010;31(9):1098-104. doi: 10.1093/eurheartj/ehp595
  53. Paterick T.E, Umland M, Jan M.F, Ammar K.A, Kramer C, Khandheria B.K, Seward J.B, Tajik A.J. Left ventricular noncompaction: A 25-year odyssey. J Am Soc Echocardiogr. 2012;25(4):363-75. doi: 10.1016/j.echo.2011.12.023
  54. Митрофанова Л.Б., Моисеева О.М., Хащевская Д.А., Митрофанов Н.А., Первунина Т.М., Заклязьминская Е.В., Ковальский Г.Б. Некомпактный миокард левого желудочка. Клинико - морфологическое исследование. Архив патологии. 2016;78(2):29-35. doi: 10.17116/patol201678229-35
  55. Sublett J.A, Prada C.E, Jefferies J.L. Case report: Left ventricular non - compaction cardiomyopathy and RASopathies. Eur J Med Genet. 2017 Sep 12. doi: 10.1016/j.ejmg.2017.09.002
  56. Мельник О.В., Гудкова А.Я., Вершинина Т.Л., Никитина И.Л., Костарева А.А., Первунина Т.М. Клинический полиморфизм РАСопатий в условиях детского кардиологического отделения. Consilium Medicum. 2017;19(12):100-4. doi: 10.26442/2075-1753_19.12.100-104
  57. D'Ascenzi F, Pelliccia A, Natali B.M, Bonifazi M, Mondillo S. Exercise - induced left - ventricular hypertrabeculation in athlete’s heart. Int J Cardiol. 2015;181:320-2. doi: 10.1016/j.ijcard.2014.11.203
  58. Gati S, Papadakis M, Papamichael N.D, Zaidi A, Sheikh N, Reed M, Sharma R, Thilaganathan B, Sharma S. Reversible de novo left ventricular trabeculations in pregnant women: implications for the diagnosis of left ventricular noncompaction in low - risk populations. Circulation. 2014;130(6):475-83. doi: 10.1161/CIRCULATIONAHA.114.008554
  59. Song Z.Z. The treatment of noncompaction of ventricular myocardium. Cardiovasc Ther. 2011;29(5):315-21. doi: 10.1111/j.1755-5922.2010.00174.x
  60. Kornberger A, Stock U.A, Risteski P, Beiras Fernandez A. Left ventricular non - compaction cardiomyopathy and left ventricular assist device: a word of caution. J Cardiothor Surg. 2016;11(1):108. doi: 10.1186/s13019-016-0503-2
  61. Uribarri A, Rojas S.V, Avsar M, Hanke J.S, Napp L.C, Berliner D, Bavendiek U, Bauersachs J, Bara C, Sanchez P.L, Haverich A, Schmitto J.D. First series of mechanical circulatory support in non - compaction cardiomyopathy: Is LVAD implantation a safe alternative? Int J Cardiol. 2015 Oct 15;197:128-32. doi: 10.1016/j. ijcard.2015.04.046
  62. Balsara K.R, Bierhals A, Vader J, Pasque M.K, Itoh A. Implantation of left ventricular assist device in a patient with left ventricular non - compaction. J Cardiac Surg. 2017;32(2):159-61. doi: 10.1111/jocs.13088
  63. Lee G.H, Kim D.K, Song Y.J, Yang J.I, Shin H.C, Ong S, Lee H.Y. Stroke in a Young Individual with Left Ventricular Noncompactionand Left Atrium Standstill. Korean Circ J. 2015;45(5):432-8. doi: 10.4070/kcj.2015.45.5.43
  64. Sun H, Zhao Q, Wang Y, Lakin R, Feng H, Fan X, Luo H, Gao D, Liu L, He Y, Yang P. Daily 10 mg rivaroxaban as a therapy for ventricular thrombus related to left ventricular non - compaction cardiomyopathy: A case report. Medicine (Baltimore). 2018;97(4):e9670. doi: 10.1097/ MD. 0000000000009670
  65. Lim H.E, Pak H.N, Shim W.J, Ro Y.M, Kim Y.H. Epicardial ablation of ventricular tachycardia associated with isolated ventricular noncompaction. PACE. 2006;29:797-9. doi: 10.1111/j.1540-8159.2006.00438.x
  66. Kobza R, Jenni R, Erne P, Oechslin E, Duru F. Implantable cardio - verter - defibrillators in patients with left ventricular noncompaction. Pac Clin Electrophysiol. 2008;31(4):461-7. doi: 10.1111/j.1540-8159.2008.01015.x
  67. Bhat T, Costantino T, Bhat H, Olkovsky Y, Akhtar M, Teli S, Culliford A. Long - term myocardial recovery after mitral valve replacement in noncompaction cardiomyopathy. J Cardiothor Surg. 2011;6:124. doi: 10.1186/1749- 8090-6-124

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