1
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Morin C, Ponzio A, Guirgis M, Benzouid C, Beyler C, Rosenblatt J. Prenatal diagnosis of congenital ventricular aneurysm and diverticulum: prenatal features and perinatal management. Prenat Diagn 2022; 42:428-434. [PMID: 35238062 DOI: 10.1002/pd.6122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/05/2022] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Cecile Morin
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Alice Ponzio
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Maurice Guirgis
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Cherine Benzouid
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Constance Beyler
- Pediatric Cardiology Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
| | - Jonathan Rosenblatt
- Fetal Medicine Unit, Hopital Universitaire Robert Debré, APHP, Paris, France
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George N, Chowdhury UK, Singh S, Sankhyan LK, Sushamagayatri B, Sengupta S, Malik V, Angadi S. A Review on the Surgical Management of Subvalvular Aneurysm. World J Pediatr Congenit Heart Surg 2020; 11:325-337. [PMID: 32294005 DOI: 10.1177/2150135120907373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present perspective is a synthesis of published investigations in the setting of subvalvular aortic aneurysms. We identified 75 investigations and reviewed the clinical presentation, diagnostic modalities used, surgical techniques employed, and their outcomes. Clinical presentation, radiographic findings, transthoracic and transesophageal echocardiography, electrocardiogram-gated computerized tomography, and magnetic resonance imaging provided the diagnostic information and were used to define the disease entity before surgery. In this article, we have attempted to address several issues concerning establishment of diagnosis, varied clinical presentation, and their management. We submit that an increased appreciation of this disease entity will contribute to improved surgical management.
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Affiliation(s)
- Niwin George
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal Kumar Chowdhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - B Sushamagayatri
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjoy Sengupta
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Suryalok Angadi
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abdissa S, Nega B, Goshu D. Submitral left ventricular aneurysm: Characteristics, diagnosis, management, and outcome. J Clin Sci 2019. [DOI: 10.4103/jcls.jcls_99_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Soynov IA, Sinelnikov YS, Nichay NR, Omelchenko AY, Kornilov IA. Endoventriculoplasty of the Left Ventricle for Congenital Diverticulum. World J Pediatr Congenit Heart Surg 2016; 8:227-230. [PMID: 27098606 DOI: 10.1177/2150135115625204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- I A Soynov
- 1 Department of Pediatric Cardiac Surgery, Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - Yu S Sinelnikov
- 2 Department of Congenital Heart Disease, Federal Center of Cardiac Surgery, Perm, Russian Federation
| | - N R Nichay
- 1 Department of Pediatric Cardiac Surgery, Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - A Y Omelchenko
- 1 Department of Pediatric Cardiac Surgery, Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - I A Kornilov
- 3 Department of Anesthesiology Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
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7
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Hunter LE, Pushparajah K, Miller O, Anderson D, Simpson JM. Prenatal diagnosis of left ventricular diverticulum and coarctation of the aorta. Ultrasound Obstet Gynecol 2016; 47:236-238. [PMID: 26376444 DOI: 10.1002/uog.15746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/01/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
Congenital left ventricular diverticulum (LVD) is a rare abnormality of the myocardium which has been detected previously in the fetus. Lesions have been reported from as early as 12 weeks' gestation but are more commonly detected in the mid-second trimester. Fetal presentation of LVD ranges from an abnormal four-chamber view of the heart, arrhythmia or isolated pericardial effusion to fetal hydrops with associated heart failure. Here, we describe the prenatal diagnosis of an infant with LVD originating from the left ventricular outflow tract associated with coarctation of the aorta. The diagnosis was confirmed postnatally by two-dimensional echocardiography and cardiac magnetic resonance imaging. We hypothesize that the lesion compromised antegrade flow into the transverse aortic arch, which may have contributed to underdevelopment of the aortic arch and subsequently the development of coarctation of the aorta. This is a unique case of LVD and coarctation of the aorta.
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Affiliation(s)
- L E Hunter
- Department of Congenital Heart Disease, Royal Hospital for Children, Glasgow, UK
| | - K Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - O Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - D Anderson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
| | - J M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK
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8
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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: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Gal AF, Tăbăran F, Taulescu M, Cătoi C. The first description of a congenital right ventricular cardiac aneurysm in a pigeon (Columba livia domestica, Cluj blue tumbler pigeon). Avian Dis 2013; 56:778-80. [PMID: 23397857 DOI: 10.1637/10156-040912-case.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Congenital cardiac aneurysms and diverticula are rare cardiac outpouchings first described in humans. Our paper describes a congenital cardiac aneurysm in the wall of the right ventricle in a pigeon. A number of pigeons (n = 23), Cluj blue tumblers (Aves: Columbiformes: Columbidae: Columba livia domestica), were found dead (accidental poisoning) in October 5, 2011 in Cluj-Napoca, Central Romania. One individual (a 7-mo-old male) presented with a thin-walled pouch in the wall of the right cardiac ventricle. A complete necropsy examination was performed, and samples of the heart (ca. 0.5 cm) with evident macroscopic lesions were fixed in 10% neutral buffered formalin. During the necropsy examination, a well-demarcated outpouching was noted in the wall of the right cardiac ventricle. The aneurysm had a broad communication with the corresponding ventricular chamber. Histologically, the wall of the right ventricular pouch consisted of mature fibrous connective tissue with collagen fibers and fibroblasts. No viable cardiomyocytes were found in the wall of the aneurysm. No infarction, inflammation, or granulation tissue was identified in the aneurysm. This is the first reliable record of a congenital cardiac aneurysm in a pigeon and also the first record of this cardiac anomaly in birds. Herein we describe gross and histopathologic changes of a congenital cardiac aneurysm in a pigeon.
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Affiliation(s)
- A F Gal
- Department of Pathologic Anatomy and Necropsy, Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine Cluj-Napoca, Calea Mănăştur 3-5, Cluj-Napoca, 400372, Romania.
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12
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Seo DM, Won HS, Ko JK, Jhang WK. Modified damus-kaye-stansel/dor procedure for a newborn with severe left ventricular aneurysm. Korean Circ J 2011; 41:494-6. [PMID: 21949538 PMCID: PMC3173674 DOI: 10.4070/kcj.2011.41.8.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/29/2010] [Indexed: 01/03/2023] Open
Abstract
Congenital left ventricular aneurysm (CVA) is a rare cardiac malformation. The prognosis is variable, depending on such factors as the size in comparison to the ventricular cavity, signs of heart failure, arrhythmia and so on. Most infants and young children with large aneurysm showed poor clinical outcomes. Here, we report the case of patient who was prenatally diagnosed with a large CVA, who had severe left ventricular dysfunction at 21 weeks' gestation for which she successfully underwent a modified Damus-Kaye-Stansel/Dor procedure.
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Affiliation(s)
- Dong-Man Seo
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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13
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Ohlow MA, Fuhrmann JT, Lauer B. Prevalence and spectrum of coronary artery anomalies in patients with an isolated congenital left ventricular aneurysm or diverticulum. Clin Cardiol 2011; 34:226-32. [PMID: 21319171 DOI: 10.1002/clc.20875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/17/2010] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies and frequently associated with other cardiac anomalies. The objective of our study was to investigate the prevalence and the spectrum of coronary anomalies in such patients. HYPOTHESIS The incidence of coronary anomalies is increased in patients with LVA or LVD. METHODS We assessed 117 patients with isolated LVA or LVD for the prevalence of coronary anomalies and compared the findings with an age- and sex-matched control group (n = 117) without the diagnosis of LVA or LVD. RESULTS Coronary anomalies were present in 58.1% of the study population (68 of 117). The median age of affected patients was 64 years, and 45 (38.5%) were male. Coronary anomalies were more prevalent in patients with LVA or LVD (58.1% vs 6.8%, P < 0.001), male patients (89% vs 57%, P = 0.0002), and in patients with nonapical location of LVA or LVD (24% vs 45%, P = 0.02) compared with control, whereas age and type (LVA vs LVD) had no influence (57% vs 57.6%, P = 0.4; and 58.8% vs 57.6%, P = 0.87, respectively). The number of adverse cardiac events was similar in both groups during a 4.2-year follow-up period (29% vs 19%, P = 0.09). None of the patients in our series had major coronary anomalies with potential lethal consequences. CONCLUSIONS This large single-center study suggests that the prevalence of abnormal coronary-artery anatomy in patients with isolated LVA or LVD is as high as 58.1%. However, we did not identify major coronary anomalies with potential lethal consequences, and the clinical course during follow-up was not influenced by the presence or absence of coronary anomalies.
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Betrián Blasco P, Sarrat Torres R, Albert Brotons DC, Pijuan Domènech A, Casaldáliga Ferrer J, Girona Comas J. Congenital left ventricular subaortic aneurysm in an asymptomatic child. Int J Cardiol 2011; 146:e5-6. [DOI: 10.1016/j.ijcard.2008.12.171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 12/22/2008] [Indexed: 10/21/2022]
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Herráez P, Rodríguez F, Aguirre-Sanceledonio M, Edwards JF, Suárez-Bonnet A, Espinosa de Los Monteros A. Congenital biventricular cardiac diverticula in a dog. Vet Pathol 2010; 48:456-9. [PMID: 20634411 DOI: 10.1177/0300985810375243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Multiple diverticula of the right and left cardiac ventricular walls were incidental findings at necropsy in a juvenile, male, mixed-breed dog with no clinical history of heart disease. Each saccular diverticulum had a narrow communication into the corresponding ventricular chamber. Histologically, the diverticular walls consisted mainly of collagen without elastin fibers and atrophic cardiomyocytes. No inflammation or other lesions were associated with the diverticula or the rest of the myocardium. Based on the history and pathologic findings, a diagnosis of congenital biventricular fibrous diverticula was made.
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Affiliation(s)
- P Herráez
- Department of Comparative Pathology, ULPGC, Arucas, Gran Canaria, Spain.
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Weichert J, Chiriac A, Axt-Fliedner R. Fetal diagnosis of left ventricular aneurysm of the free wall and the interventricular septum: report of two cases and review of the literature. J Matern Fetal Neonatal Med 2010; 23:1510-5. [DOI: 10.3109/14767051003678127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Ohlow MA, Lauer B, Geller JC. Prevalence and spectrum of abnormal electrocardiograms in patients with an isolated congenital left ventricular aneurysm or diverticulum. Europace 2009; 11:1689-95. [PMID: 19875399 DOI: 10.1093/europace/eup323] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies and can be associated with ECG abnormalities and rhythm disturbances. We sought to investigate the prevalence and the spectrum of ECG abnormalities in such patients. METHODS AND RESULTS We assessed 125 patients with isolated LVA or LVD for the prevalence of ECG abnormalities and compared the findings to an age- and gender-matched control group. The 12-lead ECG patterns were evaluated according to commonly used criteria and were classified into three subgroups (distinct, mildly, and minor). Fifty-four of the 125 patients (43.2%) had normal and 71 (56.8%) abnormal ECGs. Mean age was 66 years. Forty-nine (39.2%) were male. Distinct abnormal ECG patterns were more prevalent in patients with LVD (38.2 vs. 15.8%, P = 0.04), and apical location of the anomaly (36.6 vs. 16.6%, P = 0.02). Older age (>66 years) was associated with a trend for a higher prevalence of abnormal ECG pattern (33 vs. 18%, P = 0.06), whereas gender had no influence (32 vs. 16%, P = 0.14). This study also shows that the sensitivity, specificity, positive predictive value and negative predictive value of a 12-lead ECG for the diagnosis of LVA or LVD are low. CONCLUSION This large single-centre study suggests that the prevalence of abnormal ECG patterns in patients with isolated LVA or LVD is as high as 56.8%. However, ECG is not specific and sensitive to be used as a screening tool in such patients.
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Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, Bad Berka, Germany.
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Awad SM, Patel AS, Polimenakos A, Braun R, Abdulla RI. Left ventricular accessory chamber: a case report and review of the literature. Pediatr Cardiol 2009; 30:1022-5. [PMID: 19543847 DOI: 10.1007/s00246-009-9482-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
Congenital left ventricular out-pouching, consisting of left ventricular aneurysms, left ventricle diverticulae, and double-chambered left ventricle, is a rare cardiac malformation. Criteria to differentiate between left ventricular aneurysm and diverticulum are defined. Reports of left ventricular accessory chamber in the medical literature are rare. In this article, we present a case of left ventricular accessory chamber diagnosed during the late prenatal period. Review of the literature, imaging modalities used for differentiation of the nature of this lesion, and management plan are discussed.
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Pradhan M, Dalal A, Kapoor A, Kumar S, Manisha R. Fetal left ventricular diverticulum presenting as dysrhythmia: diagnosis and management. Fetal Diagn Ther 2007; 23:10-4. [PMID: 17934291 DOI: 10.1159/000109219] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2006] [Indexed: 11/19/2022]
Abstract
Congenital diverticulum of the left ventricle is a malformation, often associated with midline thoraco-abdominal defects. Here we describe a case of isolated congenital left ventricular diverticulum that presented with an abnormal four-chamber view and fetal dysrhythmia on ultrasonography. Maternal digoxin therapy was started due to significant ventricular ectopy. Restoration of fetal sinus rhythm was achieved within 48 h. Serial fetal echocardiograms were performed every week, followed by a normal vaginal delivery at term. The child is surviving at 1 year of age.
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Affiliation(s)
- Mandakini Pradhan
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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McMahon CJ, Moniotte S, Powell AJ, del Nido PJ, Geva T. Usefulness of magnetic resonance imaging evaluation of congenital left ventricular aneurysms. Am J Cardiol 2007; 100:310-5. [PMID: 17631089 DOI: 10.1016/j.amjcard.2007.02.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2006] [Revised: 02/22/2007] [Accepted: 02/22/2007] [Indexed: 10/23/2022]
Abstract
Congenital left ventricular (LV) aneurysm is a rare malformation of unknown cause that is often associated with a poor prognosis. This study was undertaken to evaluate the usefulness of cardiac magnetic resonance imaging in patients with congenital LV aneurysms and to determine the relation between clinical manifestations and the morphologic and functional characteristics of the aneurysms. Among the 26 consecutive patients with congenital LV aneurysms included, the anomalies involved the apex or free wall in 15 and the submitral myocardium in 11. Cardiac magnetic resonance provided detailed anatomic and functional assessment of the aneurysms in all patients. Compared with submitral aneurysms, apical or free-wall aneurysms were larger (24 +/- 29 vs 3 +/- 2 ml/m(2), p = 0.02), were more frequently associated with scar tissue by myocardial delayed enhancement imaging (71% vs 0%, p = 0.03), and tended to be more commonly associated with symptoms (53% vs 18%, p = 0.08). Aneurysm volume but not location correlated with LV size (r = 0.735, p <0.0001) and the ejection fraction (r = 0.774, p <0.0001). Apical or free-wall aneurysms were resected in 5 patients, with no mortality. There was 1 death after aortic valve replacement in a patient with type B Niemann-Pick disease, which was not clearly related to the LV aneurysm. The remaining 25 patients are alive at a median age of 13.5 years. In conclusion, the experience with this cohort illustrates that cardiac magnetic resonance is well suited for the morphologic and functional evaluation of congenital LV aneurysms.
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Affiliation(s)
- Colin J McMahon
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts, USA
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Betrián Blasco P, Jiménez MLA, Muñoz JA, García JS. Giant left ventricular aneurysm and aortic stenosis in a newborn. Int J Cardiol 2007; 118:e97-9. [PMID: 17395324 DOI: 10.1016/j.ijcard.2007.01.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Accepted: 01/03/2007] [Indexed: 10/23/2022]
Abstract
Congenital ventricular aneurysm (CVA) is a rare, poorly understood and potentially lethal cardiac anomaly. We report a neonatal case, remitted to our hospital due to a cardiogenic shock. Echocardiographic study revealed a severe aortic stenosis and a giant left ventricular aneurysm. Surgical intervention was carried out with extracorporeal circulation support, but without cardiac arrest, achieving aortic valvulotomy and aneurismal resection. The postoperative course was uneventful during the first 24 h, but on the second day, the patient presented a sudden unexpected cardiac arrest, not responding to the resuscitation manoeuvres.
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Abstract
Congenital left ventricular aneurysm is an uncommon cardiac malformation. A 9-year-old boy with complaints of dyspnea and palpitation was diagnosed with a left ventricular aneurysm originating from the left ventricle free wall. Aneurysm resection and endoventricular patch repair was performed. Postoperative follow-up was uncomplicated and follow-up echocardiographs showed normal left ventricular contractility.
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Affiliation(s)
- Mustafa Cikirikcioglu
- Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Swizerland
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Abstract
Ventricular aneurysms in the pediatric population are rare and no standardized method of treatment exists. We present a case of left ventricular (LV) aneurysm in an infant, 5 weeks after a balloon aortic valvuloplasty for congenital aortic stenosis.
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Affiliation(s)
- Sorin V Pusca
- Division of Cardiac Surgery, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia 30322, USA
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El Kady D, Gerscovich EO, Moon-Grady A, Towner D, McGahan JP, Rhee-Morris L, Naderi S. Congenital cardiac left ventricular aneurysm with pericardial effusion: early prenatal diagnosis and intervention. J Ultrasound Med 2005; 24:1011-5. [PMID: 15972717 DOI: 10.7863/jum.2005.24.7.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Dina El Kady
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Prefumo F, Bhide A, Thilaganathan B, Carvalho JS. Fetal congenital cardiac diverticulum with pericardial effusion: two cases with different presentations in the first trimester of pregnancy. Ultrasound Obstet Gynecol 2005; 25:405-408. [PMID: 15747330 DOI: 10.1002/uog.1855] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Two cases of fetal congenital cardiac diverticula diagnosed at 14 and 12 weeks of gestation are reported. Both presented with a large pericardial effusion. One fetus presented with increased NT which evolved into fetal hydrops. Pericardiocentesis at 16 weeks led to progressive resolution of hydrops. The other showed no hemodynamic compromise, normal nuchal translucency (NT) and spontaneous regression of the effusion. Both children were well at 22 and 17 months of age at the time of writing.
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Affiliation(s)
- F Prefumo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Current awareness in prenatal diagnosis. Prenat Diagn 2002; 22:949-55. [PMID: 12398087 DOI: 10.1002/pd.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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