Reversible Left Ventricular Hypertrabeculation and Hypermetabolism Following Bentall Procedure

BACKGROUND: Left ventricular hypertrabeculation may develop secondary to hemodynamic stress rather than represent primary cardiomyopathy. Its metabolic profile remains incompletely understood. CASE SUMMARY: A 43-year-old woman presented with heart failure secondary to severe aortic regurgitation from aortic root dilatation. Imaging demonstrated left ventricular dilation, reduced ejection fraction (39.0%), and prominent hypertrabeculation. 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography, following a high-fat, low-carbohydrate diet with 18-hour fasting, showed increased myocardial uptake (SUVmax 4.20). She underwent a Bentall procedure with coronary bypass grafting. Histopathology revealed cystic medial degeneration and mild interstitial fibrosis. During 4-year follow-up, ventricular dimensions decreased (59/48-43/32 mm), ejection fraction improved to 52.8%, and trabeculation regressed. Repeat FDG positron emission tomography/computed tomography demonstrated resolution of uptake (SUVmax 1.81). DISCUSSION: Parallel regression of trabeculation and FDG uptake supports adaptive remodeling rather than intrinsic cardiomyopathy, although geometric unloading may contribute. TAKE-HOME MESSAGE: Correction of volume overload may normalize ventricular structure and metabolism.