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Hypoxia exacerbated by mechanical ventilation: when the trap door opens in severe right ventricular failure
  1. Andrei D Margulescu1,2,
  2. Richard Wheeler1,
  3. Fong T Leong1
  1. 1Department of Cardiology, University Hospital of Wales, Cardiff, UK
  2. 2University of Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
  1. Correspondence to Dr Fong T Leong, Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK; f.t.leong{at}gmx.com

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A 49-year-old man with non-ischaemic cardiomyopathy presented with acute hypoxia. Weeks earlier, his right ventricle was found to be severely impaired in function, with signs suggestive of extensive myocardial fibrosis (figure 1), while his left ventricle had an ejection fraction of 33% and patchy tissue abnormalities. Despite comprehensive testing then, including biopsies from both ventricles, the cause of his cardiomyopathy remained unclear.

Figure 1

Cardiac magnetic resonance image (short axis view at the level of the papillary muscles). There is dilatation and extensive late gadolinium enhancement of …

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