Left ventricular apical diverticulum associated with double outlet right ventricle

Abstract

Corresponding author: Muhammet Akyuz, M.D. Ege Universitesi Tip Fakultesi Kalp ve Damar Cerrahisi Anabilim Dali, 35100 Bornova, Izmir, Turkey. Tel: +90 232 388 11 15 e-mail: drmak100@gmail.com A six-year-old boy was admitted to our hospital for surgery for cardiac anomaly. The patient’s medical history included a right 5 mm sided modified Blalock-Taussig shunt through median sternotomy incision. Physical examination was normal, except a pulsatile mass localized in the epigastric area starting near inferior portion of the xiphoid process. Transthoracic echocardiography revealed double outlet right ventricle, subaortic ventricular septal defect, pulmonary stenosis, and patent right-sided shunt. An outpouching in the left ventricle apex which freely communicated with the left ventricle cavity through a narrow neck was observed. The diverticulum showed characteristics synchronous contractility with the left ventricle. The patient had normal left ventricular function without any evidence of thrombus in the left ventricular cavity or diverticulum. Cardiac computed tomography images revealed focal outpouching in the apical wall of the left ventricle, consistent with a congenital muscular diverticulum of the left ventricle apex (Figure 1). The patient was operated through re-median sternotomy incision and the apical diverticulum was visualized (Figure 2). After initiating cardiopulmonary bypass, Rastelli procedure was performed. At the end of the procedure, the left ventricular diverticulum was resected and primarily closed.