Congenital Left Ventricular Diverticulum

Congenital Ventricular Diverticulum

Herein, we describe a 54-year-old patient with a congenital ventricular diverticulum (CVD), referred to our emergency department for presyncope episodes and multiple re-entrant ventricular tachycardias (VT). Significantly, echocardiographic findings were not clear, and the diagnosis was made by cardiac magnetic resonance imaging (CMRI), which showed the presence of an apical accessory cavity connected to the ventricle and contracting synchronously. CMRI allowed the differential diagnosis with other outpouching cardiac defects. The patient underwent a subcutaneous implantable cardioverter defibrillator (S-ICD) implant and was referred for heart transplantation (HT). The diagnosis, treatment, and main findings of the CVD are discussed in this case report.

Left ventricular diverticulum in association with bicuspid aortic valve and pseudocoarctation: Hitherto unreported association

Left ventricular diverticulum is a rare cardiac abnormality characterised by focal protrusion of the ventricular wall containing all the three layers with synchronous contractility. They have been described more commonly in paediatric patients and may be seen associated with congenital midline thoracoabdominal abnormalities. There are few reports of left ventricular diverticulum in cases of patent ductus arteriosus and coarctation with subaortic diverticula in the bicuspid aortic valve. Here, we report a case of left ventricular diverticulum in association with bicuspid aortic valve and pseudocoarctation in a 53-year-old female patient with a pertinent review of the literature.

Left ventricular diverticulum: A case report and review of the literature

Left ventricular diverticulum is a rare congenital left ventricular outpouchings. The disease is often diagnosed during childhood because it is frequently associated with midline thoracoabdominal defects and other congenital cardiac anomalies. Most cases are asymptomatic, often discovered incidentally. Some complications have been reported including infarction, arrhythmia, heart failure. The most severe complication is rupture of the diverticulum, which can cause a patient's death. Therefore, this congenital defect should be detected early to assess potential risks for appropriate treatment. In this article, we report a case of a 3-month-old boy with left ventricular diverticulum diagnosed with Doppler ultrasound and cardiac MSCT. Complete resection was undertaken. The patient remained asymptomatic with good heart function 2 months after surgery.

Congenital Left Ventricular Diverticulum Complicated by Cardioembolic Stroke

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Congenital LVD is a rare cause of stroke in young patients.

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LVD results from replacing myocardium with fibrous or muscular tissue.

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Diverticulum and pseudoaneurysm are in the differential diagnosis of LV outpouching.

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LVD forms a cavity that communicates with the LV through a short neck.

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LVDs that result in thrombus formation and stroke should be resected.

Interventricular septal diverticulum and rheumatic mitral valve disease identified and managed concurrently in middle age

Cardiac diverticula represent an extremely rare but serious cause of cardiac morbidity and mortality. They can result to arrhythmia, sudden cardiac death and ventricular dysfunction but may have no pathological implications. Here is a case of a 60-year-old Maori farmer with both rheumatic mitral valve disease and left ventricular (LV) septal diverticulum. The requirement for mitral valve replacement raised the complex decision of whether to undergo concurrent diverticulum repair. The haemodynamic significance of the diverticulum was impossible to ascertain, although we could not in good conscience leave such a large diverticulum with potential to influence further systolic deterioration. Three months after the procedures, the patient developed severe tricuspid regurgitation which is a first reported association postseptal diverticulum repair. The case highlights that careful consideration is required in repairing LV septal diverticula and an emphasis should be placed on complications and the requirement for repeat surgery during the consent process.

Multimodality Imaging and Clinical Significance of Congenital Ventricular Outpouchings: Recesses, Diverticula, Aneurysms, Clefts, and Crypts

The high spatial resolution of cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) permit the diagnosis of congenital ventricular outpouchings (CVOs), including congenital ventricular diverticula (CVD), congenital ventricular aneurysms (CVA), clefts, and crypts. A unique classification has not been established, and these terms are used interchangeably with confounding terminology. Moreover, their significance is not univocal. A research was performed using PubMed on six subjects: (1) congenital left ventricular outpouchings; (2) congenital ventricular diverticulum; (3) congenital ventricular aneurysm; (4) ventricular clefts; (5) ventricular crypts; and (6) ventricular crevices. Usually, CVOs are small with a preserved contraction and in asymptomatic patients, the clinical relevance may be minimal, although electrocardiographic anomalies are often present. CVA and diverticula may carry an embolic risk and cases of arrhythmia and rupture are described. In the presence of clefts, or crypts a cardiomyopathy should be excluded. A simple classification can be proposed: CVD extend beyond the myocardial wall and fibrous type may be termed CVA, acquired forms should be kept distinct. Clefts, or crypts, are small recesses extending for more than 50% of the ventricular wall but not beyond its margin. The presence of fibrosis may be evaluated by CMR. A multicenter prospective registry would be helpful to investigate potential clinical implications and to exclude dubious forms of hypertrophic cardiomyopathy or ventricular noncompaction. In conclusion, CVOs have been described with different terminologies and classifications. Their significance needs to be interpreted in the clinical setting and with the help of a multimodality imaging, particularly of CMR.

Isolated congenital cardiac diverticulum originating from the left ventricular apex: Report of a pediatric case

Congenital ventricular diverticulum is a rare cardiac anomaly defined as a localized protrusion of the ventricular free wall. Although, it is usually asymptomatic, complications such as embolism, infective endocarditis, and arrhythmias can occur. The diagnosis can be made by echocardiography, cardiac magnetic resonance imaging, or catheter angiography. Surgical resection is the treatment of choice in symptomatic patients, whereas the management of asymptomatic patients often represents a therapeutic dilemma. We report here, a 9-month-old patient with asymptomatic congenital left ventricular (LV) diverticulum associated with epigastric hernia.

Endoventriculoplasty of the Left Ventricle for Congenital Diverticulum

Congenital left ventricular diverticulum is an extremely rare heart defect. Here, we report a case of successful endoventriculoplasty using a Dacron patch in an infant who was followed up for one year.

Diverticulum, or not Diverticulum, That Is the Question! Discussing About a Case of Left Ventricular Outpouching Associated With Bicuspid Aortic Valve Assessed by Cardiac Magnetic Resonance

Congenital left ventricular outpouchings (LVOs) are infrequent myocardial malformations, comprising various overlapping abnormalities, whose characterization is often intricate in clinical practice using traditional non-invasive techniques. We describe a rare case of LVO associated with bicuspid aortic valve incidentally found in an asymptomatic adult patient. The LVO was located at basal level of the chamber, crescent-shaped with its largest diameter in short-axis view and presented a thin hypo-contractile wall without hyperintense areas on late gadolinium enhanced (LGE) images. This description corresponds to an overlap between usual definition of aneurism, fibrous and muscular diverticulum. The LVO was evaluated according with a classification recently proposed by Malakan Rad. In this case ventricular geometry was not respected, wall thickness was reduced and wall motion compromised therefore corresponding to a small IIc-type, which is considered having the poorest prognosis. Furthermore, the association with bicuspid aortic valve is very unusual. The patient refused surgery and preferred follow-up.

Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816

BACKGROUND

Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients.

METHODS

MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients.

RESULTS

We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04).

CONCLUSIONS

LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.

Congenital left ventricular diverticulum diagnosed by echocardiography

Congenital left ventricular diverticulum is a rare cardiac malformation. The incidence of left ventricular diverticulum is reported to be 0.05% of all congenital heart malformations. This case series comprised three infants with the diagnosis of congenital left ventricular diverticulum determined by echocardiography. In addition, two of the three babies also were detected to have other cardiac disease. Echocardiography is a useful tool for diagnosing congenital left ventricular diverticulum.

Left Ventricle Diverticulum with Partial Cantrell's Syndrome

Cantrell syndrome is a very rare congenital disease associating five features: a midline, upper abdominal wall disorder, lower sternal abnormality, anterior diaphragmatic defect, diaphragmatic pericardial abnormality, and congenital abnormalities of the heart. In this paper, we report a case of partial Cantrell's syndrome with left ventricular diverticulum, triatrial situs solitus, ventricular septal defect, dextrorotation of the heart, an anterior pericardial diaphragmatic defect, and a midline supraumbilical abdominal wall defect with umbilical hernia. The 5-month-old patient underwent a successful cardiac surgical procedure. A PTFE membrane was placed on the apex of the heart to facilitate reopening of the patient's chest. Postoperative course was uneventful. The patient was discharged with good clinical condition and with a normal cardiac function.

Percutaneous transcatheter device closure of an isolated congenital LV diverticulum: first case report

A congenital left ventricular diverticulum is a rare cardiac malformation. It is a developmental anomaly that occurs during embryogenesis. Presentations vary from asymptomatic patients to sudden death. To date, the treatment described has been surgical correction. The authors report the first transcatheter closure of an isolated congenital left ventricular diverticulum in a 12-year-old symptomatic girl.

Fetal Bifid Left Ventricular Diverticulum Presenting With Ventricular Ectopy

We report the diagnosis and outcome of a fetus with an unusual left ventricular wall defect. A 34-week fetus presented for echocardiographic evaluation because of an irregular cardiac rhythm. Fetal echocardiography revealed frequent ventricular ectopy and an “accessory” ventricular chamber diagnosed as a left ventricular diverticulum (LVD). The ectopy resolved in utero but recurred after delivery. Angiography revealed a “bifid” LVD. Inderal therapy suppressed the ventricular ectopy. The association between ventricular ectopy and LVD is unusual, but the prognosis of LVD even with arrhythmia is excellent.