Isolated Cardiac Sarcoidosis With Marfan Syndrome Following Cardiovascular Surgery: A Case Report.

A 55-year-old male patient with Marfan syndrome presented with exertional dyspnea. The patient had undergone aortic valve and ascending aortic replacement and experienced two admissions for congestive heart failure. His thoracic echocardiography revealed severe left ventricular systolic dysfunction with regional wall motion abnormalities and an apical aneurysm. Meanwhile, coronary angiography showed no significant stenosis. Cardiac magnetic resonance imaging demonstrated wall thinning and late gadolinium enhancement (LGE) in the apical, inferior, and inferolateral segments, corresponding to focal-on-diffuse myocardial uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. No extracardiac sarcoid lesions were identified. Moreover, right ventricular endomyocardial biopsy was nondiagnostic. Based on the multimodality imaging and laboratory findings, a clinical diagnosis of isolated cardiac sarcoidosis was established according to current guidelines. The patient underwent cardiac resynchronization therapy with defibrillator implantation followed by corticosteroid therapy, with no subsequent heart failure events. This case highlights the importance of considering inflammatory cardiomyopathy for postoperative heart failure in patients with Marfan syndrome.