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Isolated Congenital Left Ventricular Diverticulum of the Fetal Heart in a Twin Pregnancy: Case Report and Literature Review. JOURNAL OF FETAL MEDICINE 2022. [DOI: 10.1007/s40556-021-00331-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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2
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Prenatal diagnosis of accessory mitral valve tissue in a fetus with persistent dysrhythmia. Egypt Heart J 2022; 74:26. [PMID: 35403983 PMCID: PMC9001766 DOI: 10.1186/s43044-022-00263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 04/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Accessory mitral valve tissue (AMVT) is a rare congenital cardiac anomaly that mainly diagnosed in the first decade of life. However, asymptomatic cases may not be diagnosed even up to adulthood. We report a fetus with AMVT to show the diagnostic ability of the fetal echocardiography for detection of this pathology in the prenatal period. Case presentation AMVT was diagnosed in a 26-week-old male fetus with persistent dysrhythmia. Dysrhythmia could not be aborted and controlled by sotalol till the third trimester evaluation. Apical left ventricular (LV) diverticulum was the additional finding in his fetal echocardiogram. After birth, he was in sinus rhythm and echocardiography confirmed the presence of AMVT, however, without any evidence of LV apical diverticulum.
Conclusions The diagnosis of AMVT in the prenatal period is possible by fetal echocardiography. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-022-00263-z.
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3
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Schoeneberg LA, Zakaria D, Bolin EH, Eble BK, Miquel-Verges F, Sandlin AT, Bornemeier RA. A Fetal Presentation of a Ruptured Right Ventricular Diverticulum. Pediatr Cardiol 2021; 42:978-980. [PMID: 33725147 DOI: 10.1007/s00246-021-02572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
Ruptured diverticula and ventricular aneurysms are rare in the fetus, with a limited number of case reports published previously. Additional fetal complications secondary to these ventricular wall abnormalities can be seen. Interventional measures can be considered and attempted either in utero or postnatally to improve the chance of survival. We present a case of a ruptured diverticulum in a fetus and the clinical course.
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Affiliation(s)
- Laura A Schoeneberg
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA.
| | - Dala Zakaria
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Elijah H Bolin
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Brian K Eble
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Franscesca Miquel-Verges
- Department of Pediatrics (Neonatology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Adam T Sandlin
- Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
| | - Renee A Bornemeier
- Department of Pediatrics (Cardiology), University of Arkansas for Medical Sciences and Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202, USA
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4
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Wang Y, Liu C, Yin A, Zhao X, He W, Xiong Y, Fang L, Wu J. Prenatal diagnosis of fetal right ventricular diverticulum with massive pericardial effusion in one of monochorionic diamniotic twins: a case report with a favorable outcome following in utero pericardiocentesis. J Int Med Res 2021; 49:300060520986668. [PMID: 33478307 PMCID: PMC7841867 DOI: 10.1177/0300060520986668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/10/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Congenital ventricular diverticulum is a rare abnormality that may occur as an isolated malformation. Most cases are accompanied by pericardial effusion. Prenatal counseling can be difficult because the prognosis is uncertain and there is no consensus approach to prenatal management.Case presentation: We describe a case of congenital cardiac diverticulum complicated by large pericardial effusion in one of monochorionic diamniotic twins. The case was diagnosed by ultrasonography at 21 weeks of gestation. Therapeutic pericardiocentesis at 22 weeks resulted in complete resolution of the effusion and led to a favorable fetal outcome. We summarize the interventions and pregnancy outcomes in cases of cardiac diverticula reported in the literature. CONCLUSIONS Better awareness of clinical features, in utero therapies, and pregnancy outcomes could help define and improve prenatal management of congenital ventricular diverticula.
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Affiliation(s)
- Yunan Wang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Chang Liu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Aihua Yin
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Xin Zhao
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Wei He
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Ying Xiong
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Liyuan Fang
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
| | - Jing Wu
- Medical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
- Maternal and Children Metabolic-Genetic Key Laboratory, Guangdong Women and Children Hospital, Guangzhou, Guangdong, China
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5
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Shuplock JM, Kavanaugh-McHugh A, Parra D. Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature. Pediatr Cardiol 2020; 41:272-281. [PMID: 31728571 DOI: 10.1007/s00246-019-02252-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
Congenital ventricular outpouchings (CVOs) are rare congenital heart defects with limited data regarding prognosis and outcomes. We aimed to describe the characteristics, outcomes and factors associated with morbidity and mortality of prenatally diagnosed CVOs using our institutional experience and a review of published cases. A total of 86 cases of prenatally diagnosed CVOs were identified, including 3 from our institution and 83 cases identified from a review of the literature. Fetal and postnatal outcomes were analyzed for each case. Pericardial effusions (44%) and ventricular dysfunction (17%) were the most common associated findings. Excluding cases that resulted in pregnancy termination, mortality was 17%, with the majority (11/13) occurring in the prenatal period. Factors associated with mortality included an outpouching located on the left ventricle, a diagnosis of hydrops fetalis, the presence of a pericardial effusion, and an earlier gestational age at diagnosis. Of those that survived to delivery, 57% remained asymptomatic without the need for intervention, and the outpouching regressed or resolved in an additional 15%. Prenatally diagnosed congenital ventricular outpouchings are a dynamic form of congenital heart disease with a high fetal mortality rate. The outcomes associated with the outpouchings appear to be the most variable in the prenatal period and the first year after birth. Serial prenatal and postnatal evaluations should be performed to evaluate for a change in the characteristics of the outpouching.
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Affiliation(s)
- Jacqueline M Shuplock
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA.
| | - Ann Kavanaugh-McHugh
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA
| | - David Parra
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA
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6
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Marchesi M, Boracchi M, Gentile G, Maghin F, Zoja R. Sudden perinatal death due to rupture of congenital cardiac diverticulum. Pathological findings and medico-legal investigations in malpractice charge. Leg Med (Tokyo) 2017; 28:6-9. [PMID: 28728073 DOI: 10.1016/j.legalmed.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/06/2016] [Accepted: 07/11/2017] [Indexed: 11/17/2022]
Abstract
Congenital diverticula of the left ventricle, very rare malformations, are determined by an abnormal embryonic development of the ventricular wall and can be isolated or associated to other cardiac anomalies. In most of the cases, these pathologies are not symptomatic and in some patients can be associated to ventricular arrhythmia, cardiac rupture with tamponade and sudden death. Authors are presenting the case of a sudden death in an 8-weeks-old newborn due to rupture of a cardiac congenital diverticulum of the left ventricle, discovered only at the moment of the autopsic examination. The parents of the victim pressed charges against the medical staff that was appointed to the cares, blaming them with malpractice. The missed diagnosis of a cardiac congenital diverticulum of the left ventricle, a rare pathology, reflects the trickiness of the medical management that can lead to medico-legal controversies and, even though such rare conditions must be always taken into consideration when investigating possible dysfunction causing the death, diagnostic difficulties, in the case in exam, justify the missed diagnosis intra-vitam of cardiac ventricular diverticulum.
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Affiliation(s)
- Matteo Marchesi
- Responsabile USS Medicina Legale, Azienda SocioSanitaria Papa Giovanni XXIII, Ospedale di Bergamo, Italy
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Francesca Maghin
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37, 20133 Milano, Italy.
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Strzelecka I, Respondek-Liberska M, Słodki M, Zych-Krekora K, Cuneo B. Review Paper. Transplacental Digoxin Treatment In Prenatal Cardiac Problems In Singleton Pregnancies - Meta Analysis (Based On Literature: 1992–2015). PRENATAL CARDIOLOGY 2017. [DOI: 10.1515/pcard-2016-0009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Based on fourteen case reports from various centres from 1992-2015 and three original studies in 2006-2011, 122 fetuses were subjected to analysis. In these reports, transplacental digoxin treatment was administered to different cardiac anomalies such as SVT , Ebstein’s anomaly, critical AS , absent pulmonary valve syndrome, complete heart block, in foetuses with aneurysm/diverticulum of LV, in tricuspid atresia or dysplasia, rhabdomyoma, pulmonary atresia, HLHS with fibroelastosis, in TTTS and in extracardiac anomalies such as atriovenous malformation or sacrococcygeal teratoma. There was no statistical difference to suggest (Chi-square test) that digoxin was more efficient to control fetal arrhythmias than fetal congestive heart failure in nonarrhythmic patients.
Conclusions: Foetal cardiac insufficiency may appear due to different reasons (in normal heart anatomy or in heart defects, in normal sinus rhythm or due to foetal arrhythmias: tachycardias or severe bradycardia) and may be a cause of intrauterine demise. So far, we do not have strong evidence that digoxin treatment may prevent foetal death or prematurity. More research is needed to ascertain if the prolonging of pregnancy resulted from digoxin treatment or if improvement in foetal circulatory insufficiency was influenced by spontaneous regression of foetal cardiac symptoms.
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Affiliation(s)
- Iwona Strzelecka
- Medical University of Lodz, Department of Embryology and Histology Poland
- Department of Diagnoses and Prevention Fetal Malformations, Medical University of Lodz, Poland
| | - Maria Respondek-Liberska
- Department of Diagnoses and Prevention Fetal Malformations, Medical University of Lodz, Poland Poland
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Maciej Słodki
- Department of Prenatal Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland Poland
- Faculty of Health Sciences. The State University of Applied Sciences in Plock, Poland
| | - Katarzyna Zych-Krekora
- Department of Diagnoses and Prevention Fetal Malformations, Medical University of Lodz, Poland
| | - Bettina Cuneo
- Heart Institute, Department of Pediatrics Children’s Hospital Colorado and the University of Colorado School of Medicine, Aurora CO, United States of America
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Dipak NK, Venkatesh S, Prabhu S, Rao S. Evolution of ventricular outpouching through the fetal and postnatal periods: Unabating dilemma of serial observation or surgical correction. J Saudi Heart Assoc 2016; 29:203-210. [PMID: 28652674 PMCID: PMC5475357 DOI: 10.1016/j.jsha.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/10/2016] [Accepted: 10/13/2016] [Indexed: 02/01/2023] Open
Abstract
Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele) and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.
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Affiliation(s)
- Niraj Kumar Dipak
- Department of Neonatology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, aIndia
| | - Sumitra Venkatesh
- Department of Pediatric Cardiology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, bIndia
| | - Shakuntala Prabhu
- Department of Pediatric Cardiology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, bIndia
| | - Sudha Rao
- Department of Neonatology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, aIndia
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Fetal Right Ventricular Diverticulum Detected by Prenatal Ultrasound Screening. Case Rep Obstet Gynecol 2016; 2016:6382920. [PMID: 27818814 PMCID: PMC5080481 DOI: 10.1155/2016/6382920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 12/02/2022] Open
Abstract
Prenatal ultrasound screening has allowed for the detection of in utero cardiac abnormalities. Specifically, distinction is possible between ventricular diverticula and aneurysms, which is important because each condition has a different clinical outcome. We report the case of a 35-year-old, gravida 1, para 1 woman, with no significant past medical history, who underwent routine prenatal ultrasound screening at 32 weeks' gestation. A four-chamber ultrasound of the fetal heart combined with M-mode echocardiography showed abnormal dilatation of the right ventricular chamber measuring 2.2 cm × 1.0 cm but with normal contractility. Delivery was performed at full term by cesarean section, and a right ventricular diverticulum was confirmed by postnatal cardiac computed tomography. The baby developed normally with no cardiac sequelae during followup. This case demonstrates the importance of making a correct diagnosis of ventricular diverticula by prenatal ultrasound when abnormal dilatation of the fetal ventricle is identified during routine screening. Because evaluating the wall contractility by M-mode ultrasound leads to evaluating whether it has the myocardium, we conclude that M-mode echocardiography is effective for the purpose of prenatal cardiac diagnosis and can distinguish between ventricular aneurysms and functioning ventricular diverticula.
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Abstract
A congenital left ventricular diverticulum is a rare prenatal finding. The four‐chamber view of the heart is a standard part of the 18–20 week morphology scan, and evaluation of the heart with colour Doppler imaging has greatly enhanced the detection of rare and subtle cardiac anomalies.
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Affiliation(s)
- Debra Paoletti
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Canberra Australian Capital Territory Australia
| | - Meiri Robertson
- Fetal Medicine UnitDivision of Women Youth and ChildrenCanberra HospitalCanberraAustralian Capital TerritoryAustralia; Department of Obstetrics and GynaecologyAustralian National University Medical SchoolActonAustralian Capital TerritoryAustralia
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Prenatal Diagnosis of Cardiac Diverticulum with Pericardial Effusion in the First Trimester of Pregnancy with Resolution after Early Pericardiocentesis. Case Rep Obstet Gynecol 2015; 2015:154690. [PMID: 26558121 PMCID: PMC4618333 DOI: 10.1155/2015/154690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/06/2015] [Accepted: 09/13/2015] [Indexed: 12/02/2022] Open
Abstract
Cardiac diverticulum is a rare anomaly, which may present in association with pericardial effusion. Only few cases diagnosed during fetal life have been published and only in 12 cases pericardiocentesis was made with good postnatal outcomes in 83% of the cases. In the first trimester of pregnancy only 6 cases were reported. We described the largest series of cases published. We describe a case of cardiac diverticulum complicated with pericardial effusion during the first trimester of pregnancy and resolved by intrauterine pericardiocentesis at 17 weeks of pregnancy. We made a systematic review of the literature with the cases reported of cardiac diverticulum, management, and outcomes.
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12
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Ohlow MA, von Korn H, Lauer B. Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816. Int J Cardiol 2015; 185:34-45. [PMID: 25782048 DOI: 10.1016/j.ijcard.2015.03.050] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany.
| | - Hubertus von Korn
- Medizinische Klinik I, Krankenhaus Hetzelstift, Neustadt/Weinstrasse/Weinstrasse, Germany
| | - Bernward Lauer
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany
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13
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Peters C, Wacker-Gussmann A, Strasburger JF, Cuneo BF, Gotteiner NL, Gulecyuz M, Wakai RT. Electrophysiologic features of fetal ventricular aneurysms and diverticula. Prenat Diagn 2014; 35:129-36. [PMID: 25284224 DOI: 10.1002/pd.4501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/03/2014] [Accepted: 09/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Congenital ventricular wall defects are very rare and include congenital ventricular aneurysms (CVAs) and diverticula (CVDs). METHOD We report a series of five fetuses: three with CVAs and two with CVDs referred due to fetal arrhythmia. In addition to routine fetal echocardiography, fetal magnetocardiography (fMCG) was used. The literature in CVA and CVD is reviewed. RESULTS Incessant premature ventricular contractions (PVC), mainly bigeminy and trigeminy were found in three fetuses with CVAs and in one with CVD, who also had ventricular couplets. The other fetus with CVD, referred because of PVCs, had only sinus tachycardia. ST elevation was noted in two. Fetal movement had a variable impact on PVCs. Postnatal evaluation demonstrated two persistent left ventricular aneurysms and one persistent right CVD; one CVD resolved at 35-week gestation. Two neonates had incessant PVCs. Both arrhythmias resolved spontaneously while being treated with propranolol. CONCLUSION FMCG is complementary to echocardiographic imaging. In fetuses with left ventricular wall defects, additional electrophysiological diagnosis can be made by fMCG, including the complexity of ventricular ectopy, arrhythmic response to fetal movement, presence of ST-T wave abnormalities, and atrial amplitude increases. Prenatal risk factor assessment using fMCG can additionally support post-natal treatment and follow-up.
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Affiliation(s)
- Carli Peters
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
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Malakan Rad E, Awad S, Hijazi ZM. Congenital left ventricular outpouchings: a systematic review of 839 cases and introduction of a novel classification after two centuries. CONGENIT HEART DIS 2014; 9:498-511. [PMID: 25159202 DOI: 10.1111/chd.12214] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis. OBJECTIVES The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs. DATA SOURCES We performed three separate sets of search on three subjects including "congenital left ventricular outpouchings," "important and simply measurable markers of left ventricular function," and "relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV." STUDY ELIGIBILITY CRITERIA We enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS We studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification. RESULTS A total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced. CONCLUSION The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.
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Affiliation(s)
- Elaheh Malakan Rad
- Section of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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15
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Ohlow MA, Brunelli M, Lauer B. Characteristics and outcome of primary congenital left ventricular aneurysm and diverticulum: analysis of cases from the literature. Prenat Diagn 2014; 34:893-9. [DOI: 10.1002/pd.4389] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 03/23/2014] [Accepted: 04/14/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology; Zentralklinik Bad Berka; Robert-Koch-Allee 9 99437 Bad Berka Germany
| | - Michele Brunelli
- Department of Cardiology; Zentralklinik Bad Berka; Robert-Koch-Allee 9 99437 Bad Berka Germany
| | - Bernward Lauer
- Department of Cardiology; Zentralklinik Bad Berka; Robert-Koch-Allee 9 99437 Bad Berka Germany
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Shah D, Kumar CP, Shah MS, Baraiya M. Case series: Congenital left ventricular diverticulum. Indian J Radiol Imaging 2011; 20:211-4. [PMID: 21042448 PMCID: PMC2963743 DOI: 10.4103/0971-3026.69356] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by USG, echocardiography, CT angiography, and MRI. We report here two neonates with congenital left ventricular apical diverticulum associated with epigastric hernia.
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Affiliation(s)
- Dharita Shah
- Department of Radio-Diagnosis, Seth Vadilal Sarabhai General Hospital, Ellisbridge, Ahmedabad - 380 016, Gujarat, India
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