Non-compaction and restrictive cardiomyopathy in pediatrics: Two types of myocardial diseases that are important to recognize

• Published in: Andes pediatrica : revista Chilena de pediatría 2021-10, Vol.92 (5), p.667-676
• Main Authors: Álvarez Zenteno, Patricia, Meza Peñafiel, Laura, Aroca Del Río, Patricia
• Format: Article
• Language: Spanish
• Subjects: Cardiomyopathies - diagnosis; Cardiomyopathies - etiology; Cardiomyopathies - therapy; Cardiomyopathy, Restrictive - complications; Cardiomyopathy, Restrictive - diagnosis; Cardiomyopathy, Restrictive - therapy; Child; Humans; Isolated Noncompaction of the Ventricular Myocardium - diagnosis; Isolated Noncompaction of the Ventricular Myocardium - genetics; Isolated Noncompaction of the Ventricular Myocardium - therapy; Pediatrics; Quality of Life
• ISSN: 2452-6053
• DOI: 10.32641/andespediatr.v92i5.3708

Left ventricular non-compaction (LVNC) and restrictive cardiomyopathies (RCM) are rare diseases with high morbidity and mortality in the pediatric age group, particularly the restrictive. They can be diagnosed at any age even in fetal life, in isolation or association with other cardiomyopathies or congenital heart disease. The causes may be genetic, neuromuscular, metabolic, storage, or idiopathic disorders. The main morphological characteristic of LVNC is the presence of a non-compact myocar dium with numerous prominent trabeculations and deep recesses, which may results in myocardial dysfunction, malignant arrhythmias and thromboembolism. On the other hand, in RCM there is an abnormal myocardial stiffness, which generates a restrictive ventricular filling and atrial dilatation secondary. Clinically it manifested by severe diastolic dysfunction, pulmonary hypertension, arrhyth mias and sudden death. For both cardiomyopathies, the Doppler color echocardiography, electro cardiography and Holter monitoring of arrhythmias are the gold standard for diagnosis and follow up. Cardiac resonance adds information on functional assessment and quantification of myocardial fibrosis. The therapy is oriented to improve symptoms and quality of life. Patients with severe forms of LVNC and RCM may require extracorporeal ventricular support and cardiac transplantation, even in early stages of the disease. The pediatrician plays an important role in the early recognition of these pathologies for timing to referral as well as in the follow-up and screening for complications. The objective of this review is to update the clinical, genetic, diagnostic, therapeutic issues and prognostic of the LVNC and RCM.