Congenital Ventricular Aneurysm Research Articles

Congenital Apical Left Ventricular Aneurysm.

A 17-year-old male was referred for evaluation by Pediatric Cardiology following a pre-sports medical screening, which revealed abnormal ventricular repolarization (negative T wave from V3-V6) on a 12-lead ECG. For 8 years, he has been a competitive football player. There was no relevant personal or family medical history, and he denied any prior cardiovascular symptoms. His cardiovascular physical examination was normal. In the initial assessment, a transthoracic echocardiogram was conducted, revealing an apical aneurysm of the left ventricle (LV) with regional dyskinesia, accompanied by mild mitral regurgitation. The examination also demonstrated globally preserved left ventricular systolic function, with no images suggestive of vegetations or intracardiac thrombi found. For further anatomical and myocardial characterization, a cardiac magnetic resonance (CMR) was performed. The results revealed a wide apical aneurysm of the LV, predominantly lateral, with thin walls, ridges within the outpouching, and local dyskinesia. No areas of late gadolinium enhancement (LGE) were found, suggestive of fibrosis, anomalous infiltration, or scar from a previous infarction. After excluding other etiologies, the diagnosis of a congenital ventricular aneurysm was determined. This is a very rare condition (0.12%) with a wide and variable clinical presentation, ranging from benign arrhythmias to sudden death. Various imaging techniques aid in its diagnosis, with CMR being particularly useful for excluding inflammation and cardiomyopathies, identifying LGE, and evaluating left ventricular volumes and function. There is no standard treatment, and controversy surrounds indications for surgical intervention. If a conservative approach is adopted, measures aimed at preventing endocarditis and embolism must be considered.

Prenatal features and postnatal follow-up of congenital ventricular outpouching: A retrospective study of two centers in China.

Congenital ventricular outpouching (CVO) is a rare cardiac malformation that can manifest as congenital ventricular aneurysm (CVA) and/or congenital ventricular diverticula (CVD). In this study, we describe the prenatal features and postnatal follow-up of 27 cases of CVO. The clinical data of 27 patients with CVO who attended Sir Run Run Shaw Hospital Affiliated to the Medical College of Zhejiang University (Zhejiang Province, China) and Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University (Zhejiang Province, China) from April 2013 to October 2022 were retrospectively analyzed. The patients were also followed up by telephone. The prenatal characteristics and postnatal outcomes of the patients with CVO were evaluated. CVO was detected in 26 cases prenatally, 14 (51.85%) were diagnosed with CVA, nine (33.33%) were diagnosed with CVD, three (11.11%) were equivocal for CVA/CVD, and one (3.70%) was detected with CVA postnatally. Six patients underwent follow-up fetal echocardiography approximately 4weeks after the initial echocardiography examination, and a significant difference in CVO size was observed between the two examinations (P=.02). Eight patients (29.63%) demonstrated cardiovascular dysfunction, and the median CVO size in fetuses with and without cardiovascular dysfunction was 205 (range: 169-396) mm2 and 124 (range: 92-154.5) mm2 , respectively (P=.01). Correlation was found between CVO size and fetal cardiac dysfunction (p=.000, r=.778). Eight patients (29.63%) had cardiac/extracardiac defects. Thirteen patients were live born, 12 were terminated pregnancies, and two were lost to follow-up. The postpartum size of the CVOs remained stable in six patients, decreased in two patients, dissolved in three patients, and were surgically removed in two patients. With the exception of one patient with CVA complicated with complex congenital cardiac malformation who underwent surgical treatment after birth and who had postoperative left ventricular dysfunction (Case 1), the prognosis of all of the patients was good. CVO is often associated with cardiac malformations. The size of prenatal CVOs can increase with gestational development, and cardiovascular dysfunction is significantly related to CVO size. The postpartum prognosis of patients with CVO is good. Echocardiography plays a key role in the diagnosis of congenital ventricular outpouching. Prenatal counseling should be cautious regarding the diagnosis and the prognosis although our cases had a favorable prognosis.

Fetal diagnosis of a right ventricular aneurysm case with favorable outcome

Objective Congenital ventricular aneurysms located in the right ventricle are very rare abnormalities. Case(s) We describe a case of prenatal diagnosed right ventricle aneurysm which ended with favorable outcome. Fetal echocardiography demonstrated a 20x20 mm aneurysmal image outpouching from the basal region and free wall of the right ventricle in a 35- year-old multigravida woman at her 37th gestation week. This case had intermittent bradycardia in the postpartum first days. In pediatric cardiology examinations at the 1st, 3rd , 6th month and 1st year postnatally, it was observed that aneurysmatic formation partially regressed compared to the prenatal period. Conclusion Prenatal diagnosis of these abnormalities allows to have a favorable prognosis via a multidiciplinary colloboration in intrauterine and postnatal period.

Characteristics and outcomes of fetal ventricular aneurysm and diverticulum: combining the use of a new technique, fetal HQ.

Congenital ventricular aneurysms or diverticulum (VA/VD) are rare cardiac anomalies with lack prenatal evaluation data. The present study aimed to provide the prenatal characteristics and outcomes from a tertiary center and the use of new techniques to evaluate the shape and contractility of these fetuses. Ten fetuses were diagnosed with VA or VD, and 30 control fetuses were enrolled. Fetal echocardiography was performed to make the diagnosis. The prenatal echo characteristics and follow-up data were carefully reviewed. The shape and contractility measurements of the four-chamber view (4CV) and both ventricles were measured and computed using fetal fetal heart quantification (HQ). A total of 10 fetuses were enrolled, including 4 cases of left ventricular diverticulum, 5 cases of left ventricular aneurysm, and 1 case of right ventricular aneurysm (RVA). Four cases chose to terminate the pregnancy. The RVA was associated with a perimembranous ventricular septal defect. Two cases had fetal arrhythmia, and one case had pericardial effusion. After birth, one case underwent surgical resection at five years old. The 4CV global sphericity index (SI) of free-wall located ventricular outpouching (VO) was significantly lower than the apical ones and the control group (p < 0.01). Four of five apical left VOs had significant higher (>95th centile) SI in base segments, and three of four left VOs in the free-wall had significant lower (< 5th centile) SI in the majority of 24 segments. Compared to the control group, the left ventricle (LV) global longitudinal strain, ejection fraction, and fractional area change were significantly decreased (p < 0.01), while the LV cardiac output of the cases was in the normal range. The transverse fraction shortening of the affected segments of ventricles was significantly lower than the other ventricle segments (p < 0.01). Fetal HQ is a promising technique to evaluate the shape and contractility of congenital ventricular aneurysm and diverticulum.

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

We wanted to describe prenatal features and post-natal outcomes of fetal cardiac out pouching. We retrospectively report 6 cases of VD 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 (3months to 3years). All six 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. 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.

Four-dimensional echocardiographic and pathologic findings of congenital left ventricular aneurysm: A case report.

The sonographic and histopathologic features of a rare case of left ventricular aneurysm are reported, detailing the method of prenatal diagnosis and suggesting possible etiology of congenital ventricular aneurysm.

Autopsy and postnatal follow-up of prenatally diagnosed ventricular outpouchings.

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. 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. 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. 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.

P727 Unexpected ventricular aneurysm: further ischemic aetiology

Abstract Introduction Ventricular aneurysm is an infrequent complication of myocardial infarction. In absence of an ischemic event, alternative aetiologies include: thoracic trauma, hypertrophic cardiomyopathy, myocarditis, Chagas disease, cardiac sarcoidosis or arrythmogenic cardiomyopathy. In the absence of any of the previous, congenital aneurysm diagnosis is made. Case We present the case of 57-year-old man referred to cardiology department because a new onset of atrial fibrillation with left bundle branch block. Past medical history included high blood pressure and dyslipidaemia without any history or smoking, alcohol consumption or any other toxic abuse. No chest pain, shortness of breath or other significant symptoms were reported. Physical examination was unremarkable except for an arrhythmic pulse at 85-90 bpm. Echocardiogram showed moderate dilated left ventricle with mild-moderate LV dysfunction (EF 40% ) with a septal aneurysm of 2.4x1cm (Picture A). A coronary CT was performed that ruled out coronary heart disease and confirmed the presence of the septal aneurysm (Picture B). To better characterize this image, a cardiac magnetic resonance (CMR) was performed. Moderate dilated LV with significant dysfunction (EF 31%) was reported. A septal aneurysm of 13 x 22 x 33 mm composed of a 2.8 m thin wall of true myocardial tissue was documented (picture C and D-late gadolinium enhance). No myocardial delayed enhancement was detected in any area of the LV. Moreover, no signs of myocardial non compaction, arrythmogenic cardiomyopathy, hypertrophic cardiomyopathy or myocarditis were seen. Chagas serology as well as sarcoidosis diagnosis work up were negative. Patient denied any thoracic traumatism. Congenital aneurysm diagnosis was finally established. Electrical cardioversion was performed after 1 month of correct oral anticoagulation and heart failure treatment was started. Case was presented in the Heart Team session and a conservative management was decided based on asymptomatic status and absence of ventricular arrhythmias. After 3 years of clinical follow up, the patients is in good status, asymptomatic and in sinus rhythm. Discussion: Congenital ventricular aneurysm is a rare cardiac malformation that arises during the fourth embryonic week. Most frequently, left ventricular aneurysms are found in the apex and the perivalvular area, being the septal location an atypical one. Most patients are asymptomatic but when symptoms occur, they are mostly related to the presence of ventricular arrhythmias. Aneurysm rupture incidence is variable, ranging from 3.7% to 12 % according to the different series. For this reason, surgery is recommended in symptomatic patients. However, management of asymptomatic patients is not clear since prognosis studies are lacking. Abstract P727 Figure. A.Echo B.-CT C.-CMR. D.-CMR gadolinium

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.

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Congenital Ventricular Crypt, Diverticulum or Aneurysm? A Finding to be Considered

Congenital Ventricular Crypt, Diverticulum or Aneurysm? A Finding to be Considered

Electrophysiologic features of fetal ventricular aneurysms and diverticula.

Congenital ventricular wall defects are very rare and include congenital ventricular aneurysms (CVAs) and diverticula (CVDs). 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. 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. 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.

Left Ventricular Aneurysm, Aortic Stenosis, and Arcade Mitral Valve: Coexistence of Three Rare Congenital Heart Defects

This report presents two fetuses with three rare congenital heart defects: congenital ventricular aneurysm, arcade mitral valve, and unicommissural aortic valve. Because interaction between the endocardium and the myocardium is essential for development of the myocardium and heart valves, the authors hypothesized that these three defects could be related to abnormal signaling between the endocardium and the myocardium during critical phases of cardiac development. This combination of defects might be incompatible with fetal survival to term.

Interrupted aortic arch, bicuspid aortic valve with severe aortic stenosis and congenital ventricular septal aneurysm in a 79-year-old woman

Interrupted aortic arch, bicuspid aortic valve with severe aortic stenosis and congenital ventricular septal aneurysm in a 79-year-old woman

Incidental multislice computed tomography finding of a congenital submitral ventricular aneurysm

Incidental multislice computed tomography finding of a congenital submitral ventricular aneurysm

Congenital Ventricular Aneurysm as an Unexpected Complication of Monomorphic Premature Ventricular Contractions

Congenital ventricular diverticulum (CVD) in adults is a rare cardiac malformation, which includes fibrous type congenital ventricular aneurysm (CVA). CVA is often clinically asymptomatic and shows no abnormality in the electrocardiogram or chest X-ray. However, some cases of sudden death resulting from ventricular tachycardia, cardiac embolism or ventricular rupture have been reported. Therefore, physicians should perform further cardiac imaging studies to detect a CVA if ventricular arrhythmia originating from the left ventricle is observed. Here, we report two successfully followed cases of CVA which were diagnosed from premature ventricular contractions.

All Cardiac Right Ventricular Outpouches Are Not Created Equal

Congenital right ventricular diverticula and aneurysms are rare. Clinically, a diverticulum is difficult to distinguish from an aneurysm. Four diverse right ventricular cameral defects or right ventricular outpouches (RVOs) are described together with the management of each. Surgery may be necessary if an RVO has thin walls. However, if an RVO is composed of uniform thick contractile walls, conservative follow-up care likely is appropriate.

Prenatally Diagnosed Right Ventricular Outpouchings: A Case Series and Review of the Literature

Congenital right ventricular aneurysms and right ventricular diverticula are rare forms of congenital heart disease for which little information exists regarding optimal management, natural history, or prognosis. With advancements in prenatal cardiac evaluation and ultrasound, the reported frequency of these lesions, as well as a better understanding of the natural history of this form of congenital heart disease, is likely to evolve. We present three cases of fetal right ventricular aneurysms/diverticula diagnosed at our institution, along with a review of the current literature. We describe the pre- and postnatal courses as well as suggest counseling and management strategies.

Fetal Diagnosis of an “Extra Cardiac Chamber”

Congenital right ventricular aneurysms and diverticula are rare congenital anomalies and prenatal detection is uncommon. Distinguishing between these two anomalies by imaging alone is difficult. Recently, we were asked to review a 21-week ultrasound that detected an "extra cardiac chamber." This represents the first report of an isolated out-pouching of the right ventricular free wall to be detected by prenatal screening ultrasound. Based on preoperative imaging, this out-pouching was diagnosed as a ventricular aneurysm, but intraoperative findings suggested it was a diverticulum. This case will review the differences between ventricular aneurysms and diverticula and illustrate the use and limitations of various imaging modalities used in their evaluation, both prenatally and postnatally. A plan of management is suggested.

Giant left ventricular aneurysm and aortic stenosis in a newborn

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.