Coronary aneurysm mimicking a five chamber heart.

et al. Influence of cardiac shape on left ventricular twist.term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyop-athy with poor prognosis. Vancrayenest D et al. Assessment of subendocardial vs. subepicardial left ventricular rotation and twist using two-dimensional speckle tracking echocardiography: comparison with tagged cardiac magnetic resonance. Importance of transducer position in the assessment of apical rotation by speckle tracking echocar-diography. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Clinical features of isolated noncompaction of the ventricular myocardium: long-term clinical course, hemodynamic properties, and genetic background. WJ et al. Diagnosis of left-ventricular non-compaction in patients with left-ventricular systolic dysfunction: time for a reappraisal of diagnostic criteria? M et al. Left ventricu-lar remodelling and torsional dynamics in dilated cardiomyopathy: reversed apical rotation as a marker of disease severity. A 47-year-old soccer trainer was referred for a precordial murmur incidentally noted on routine physical examination. Cardiac auscultation revealed a grade 4/6 continuous murmur heard best on the left sternal border. No other sign was detected on physical examination. Chest X-ray and ECG showed no abnormalities. Transthoracic echocardi-ography revealed an echo-free cavity measuring 32 × 14 mm within the interventricular septum (Panels A and B; Supplementary data online, Movie S1). Colour Doppler imaging showed a continuous, mainly diastolic flow (Supplementary data online, Movie S2) within the structure, and a hyperaemic left anterior descending artery flow entering its cavity. The heart chambers, valves, and left ventricu-lar performance were entirely normal. Computed tomography angiography demonstrated a dilated left anterior descending artery streaming into a distinct cavity measuring 5 × 3 cm near the cardiac apex (Panels C and D). The diagnosis of communication between the artery and that structure was confirmed by conventional coronary angiography. Giant coronary artery aneurysms (defined as aneurysms. 20 mm in diameter) are extremely rare. Therapeutic options include surgery or transcatheter closure. Although no clear consensus exists on the management of such a rare condition, clinically silent coronary artery aneurysms are reported to be well tolerated. A conservative approach is usually preferred. Apical four chamber (Panel A), parasternal short-axis (Panel B) computed tomography angiography images of the cavity (Panels C and D).