Fetal diagnosis of right cardiac ventricular aneurysms: A report of three cases

In Utero Presentation of Left Ventricular Aneurysm

Congenital left ventricular aneurysm, pseudoaneurysm, and diverticulum are rare entities. These diagnoses can be made pre- and/or postnatally. Although these entities overlap clinically and morphologically, important distinctions can allow for accurate diagnoses. Appropriate diagnosis can be imperative for risk stratification and guidance of prenatal and postnatal management. The case described in the present report highlights a challenging case of a fetal left ventricular aneurysm, management during the prenatal and postnatal periods, and important differentiating features from a ventricular diverticulum and pseudoaneurysm.

Prenatal diagnosis of congenital ventricular aneurysm and diverticulum: prenatal features and perinatal management

Congenital ventricular diverticulum and aneurysm are rare cardiac developmental anomalies and their pathophysiology is still unclear. They present as an anomaly of the four chambers view, cardiomegaly, arrhythmia, pericardial effusion, or hydrops. They are usually isolated anomalies. Differential diagnosis between diverticulum and aneurysm is challenging during the prenatal period. Management policy is not uniform either conservative or repeated pericardial puncture.

OBJECTIVE

We wanted to describe prenatal features and post-natal outcomes of fetal cardiac out pouching.

METHODS

We retrospectively report 6 cases of ventricular diverticulum and aneurysm prenatally managed in our fetal medicine unit between 2010 and 2020. All cases were evaluated from the first or second trimester of pregnancy until postnatal follow-up (3 months to 3 years).

RESULTS

All 6 cases underwent a monthly ultrasound follow-up with spontaneous regression of pericardial effusion, and normal hemodynamics at birth No pericardial puncture was done and postnatal outcome was favorable in all cases.

CONCLUSION

Based on our experience and on cases previously published, prenatal counseling should be prudent regarding the final diagnosis. Referral and monthly prenatal ultrasound follow-up, birth in a tertiary center after multidisciplinary evaluation and cardiological evaluation at birth still seem mandatory. This article is protected by copyright. All rights reserved.

Prenatal diagnosis of fetal right congenital ventricular aneurysms: An analysis of three cases and literature review

Right ventricular aneurysm is a rare congenital defect that can be diagnosed with fetal echocardiography. Information on etiology of right ventricular aneurysm is limited and its prognosis remains variable from asymptomatic forms to severe cases. Here we report three cases of fetal right ventricular aneurysms that could have been related to coronary artery disorders and needed regular monitoring of progression in size and signs of cardiac decompensation.

Autopsy and postnatal follow-up of prenatally diagnosed ventricular outpouchings

OBJECTIVES

Prenatal ventricular outpouchings (VOs), which include congenital ventricular aneurysms (CAs) and congenital ventricular diverticula (CD), are very rare. We describe the features and outcomes of prenatal VOs diagnosed over a 4-year period.

METHODS

Retrospective cohort study of cases of prenatal diagnoses of CAs and CD at our center between June 2014 and January 2018. The prenatal and postnatal echocardiogram data were reviewed, and telephone follow-up was conducted of liveborn cases.

RESULTS

A total of 25 VOs were identified. Two were lost to follow-up, 15 chose termination of pregnancy, and eight resulted in livebirths. Only two cases underwent autopsy: Histopathology showed that the CA wall was substituted by collagen fibers. At follow-up, none of the eight liveborn babies experienced adverse events, and three VOs near the tricuspid annulus almost disappeared, though one was extremely large.

CONCLUSIONS

In our center, all liveborn babies with VO had good prognoses. We hypothesize that VOs located near the right ventricular annulus may be caused by prenatally unbalanced pressure, given their decrease in size after birth when the right heart pressure declines.