Case Report| Volume 16, ISSUE 2, P123-126, April 2007

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Nutritional Deficiency of Selenium Secondary to Weight Loss (Bariatric) Surgery Associated with Life-Threatening Cardiomyopathy

      Nutritional deficiencies of vitamins and minerals have been associated with reversible and irreversible cardiomyopathic processes. Selenium deficient dilated cardiomyopathy, first described in 1935 in the Keshan Province of China, was sometimes reversed with selenium supplementation. In the past three decades, selenium deficient cardiomyopathy has re-emerged in western medicine secondary to gastrointestinal disorders, long-term total parenteral nutrition (TPN) and gastrointestinal surgery. This report describes a case of selenium deficient cardiomyopathy secondary to the bariatric (weight loss) surgical operation bilio-pancreatic diversion (Scopinaro procedure). This patient presented with life-threatening heart failure nine months after this surgery, having lost 100 kg of body weight. Multiple nutritional deficiencies were detected and corrected including severely depleted selenium levels. Cardiac function and the clinical scenario improved dramatically over three weeks. Screening patients at risk of malnourishment for selenium deficiency as a potential cause of cardiomyopathy is indicated.


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        • Inoko M
        • Konishi T
        • Matsusue S
        • Kobashi Y
        Midmural fibrosis of left ventricle due to selenium deficiency.
        Circulation. 1998; 98: 2638-2639
        • Fleming R
        • Lie T
        • McCall T
        • O’Brien F
        • Baillie E
        • Thistle L
        Selenium deficiency and fatal cardiomyopathy in a patient on home parenteral nutrition.
        Gastroenterology. 1982; 83: 689-693
        • Johnson R
        • Baker S
        • Fallon J
        An occidental case of cardiomyopathy and selenium deficiency.
        N Engl J Med. 1981; 304: 1210-1212
        • Lockitch G
        Selenium: clinical significance and analytical concepts.
        Clin Rev Clin Lab Sci. 1989; 27: 483-541
        • Swisher A
        • Yeater R
        Cardiomyopathy: classification, medical management and exercise.
        Cardiopul Phys Ther. 2000; 11: 31-37
        • Davies M
        The cardiomyopathies: an overview.
        Heart. 2000; 83: 469-474
        • Scopinaro N
        • Adami GF
        • Marinari GM
        Biliopancreatic diversion.
        World J Surg. 1998; 22: 936-946
        • Scopinaro N
        • Marinari G
        • Camerini G
        Laparoscopic standard biliopancreatic diversion: technique and preliminary results.
        Obes Surg. 2002; 12: 362-365
        • Burke M
        • Opeskin K
        Fulminant heart failure due to selenium deficiency cardiomyopathy (Keshan Disease).
        Med Sci Law. 2002; 42: 10-13
        • Brown K
        • Arthur J
        Selenium, selenoproteins and human health: a review.
        Public Health Nutr. 2001; 4: 593-599
        • Fryer M
        Rational for clinical trials of selenium as an antioxidant for the treatment of the cardiomyopathy of Friedreich's ataxia.
        Med Hypotheses. 2002; 58: 127-132
        • Marcus R
        Myopathy and cardiomyopathy associated with selenium deficiency: Case report, literature review, and hypothesis.
        Md Med J. 1993; 42: 669-674
        • Topol E.
        • Califf R.
        • Isner J.
        • Prystowsky E.
        • Serruys P.
        • Swain J.
        • Thomas J.
        • Thompson P.
        • Young J.B.
        • Nissen S.
        Textbook of Cardiovascular Medicine.
        Lippincott-Raven Publishers, Philadelphia1998
        • Quercia R.
        • Korn S.
        • O’Neill D.
        • Dougherty J.
        • Ludwig M.
        • Schweizer R.
        • Sigman R.
        Selenium deficiency and fatal cardiomyopathy in a patient receiving long-term home parenteral nutrition.
        Clin Pharm. 1984; 3: 531-535
        • Guangsheng L
        • Fan W
        • Deren K
        • Cai L
        Keshan Disease: an endemic cardiomyopathy in China.
        Hum Pathol. 1985; 16: 602-609
        • Cheng T
        Selenium deficiency and cardiomyopathy.
        J R Soc Med. 2002; 95: 219
        • Levander O
        • Beck M
        Interacting nutritional and infectious etiologies of Keshan disease.
        Biol Trace Elem Res. 1997; 56: 5-21
        • Lockitch G.
        • Taylor G.
        • Wong L.
        • Davidson A.
        • Dison P.
        • Riddell D.
        • Massing B.
        Cardiomyopathy associated with nonendemic selenium deficiency in a Caucasian adolescent.
        Am J Clin Nutr. 1990; 52: 572-577
        • Yang G
        • Xia Y
        Studies on human dietary requirements and safe range of dietary intakes of selenium in China and their application in the prevention of related endemic diseases.
        Biomed Environ Sci. 1995; 8: 187-201
        • Lorgeril M
        • Salen P
        • Accominotti M
        • Cadau M
        • Steghens J
        • Boucher F.
        • de Leiris J.
        Dietary and blood antioxidants in patients with chronic heart failure, insights into potential importance of selenium in heart failure.
        Eur J Heart Fail. 2001; 3: 661-669
        • Dolan K
        • Bryant R
        • Fielding G
        Treating diabetes in the morbidly obese by laparoscopic gastric banding.
        Obes Surg. 2003; 13: 439-443
        • Hatizifotis M
        • Dolan K
        • Newbury L
        • Fielding G
        Symptomatic Vitamin A deficiency allowing biliopancreatic diversion.
        Obes Surg. 2003; 13: 655-657