Left Ventricular Diverticulum Research Articles

Left ventricular apical diverticulum with aortic thromboembolism in a cat

Left ventricular apical diverticulum with aortic thromboembolism in a cat

Tratamiento endovascular exitoso de aneurisma del ventrículo izquierdo en un paciente pediátrico

Aneurysms and diverticula of the left ventricle are rare entities in childhood, with a prevalence of less than 0.1%. Described since 1886, as a severe and potentially fatal disease if not corrected, mainly due to the presence of associated anomalies and the risk of rupture. Present other management options for ventricular diverticula, different from surgical options, using alternative materials that are not used very often in daily practice. A detailed description of a case successfully managed with these new treatment modalities. Endovascular management of the left ventricular diverticulum, diagnosed prenatally in the patient presented, was successful after initial failure with surgical management. Endovascular management of ventricular diverticula, using alternative materials to those commonly used, is an attractive option with satisfactory results in these patients.

Kiosk 1Q-FA-04 - MRI Characterization of a Left Ventricular Diverticulum as a Malformation in a Patient with Pentalogy of Cantrell and Tetralogy of Fallot Associated

Kiosk 1Q-FA-04 - MRI Characterization of a Left Ventricular Diverticulum as a Malformation in a Patient with Pentalogy of Cantrell and Tetralogy of Fallot Associated

Kiosk 1Q-TA-05 - The Importance of Advanced Imaging by Cardiac Magnetic Resonance Imaging in Diagnosing Congenital Left Ventricular Diverticulum

Kiosk 1Q-TA-05 - The Importance of Advanced Imaging by Cardiac Magnetic Resonance Imaging in Diagnosing Congenital Left Ventricular Diverticulum

OP-12 Comparative case reports of prenatally diagnosed left ventricular aneurysm and diverticulum

OP-12 Comparative case reports of prenatally diagnosed left ventricular aneurysm and diverticulum

OP-12 Comparative case reports of prenatally diagnosed left ventricular aneurysm and diverticulum

OP-12 Comparative case reports of prenatally diagnosed left ventricular aneurysm and diverticulum

In Utero Presentation of Left Ventricular Aneurysm.

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

A Case of Multiple Embolic Strokes Caused by a Congenital Left Ventricle Diverticulum Undetected on Echocardiography

Congenital Left Ventricular Diverticulum (CLVD) is a rare cardiac malformation caused by a localized protrusion of the left ventricular wall and usually diagnosed with routine echocardiography. CLVD is often associated with other cardiac and noncardiac abnormalities, but it can also occur alone. When echocardiography is non diagnostic, other noninvasive techniques such as cardiac CT (CCT) and Cardiac MR (CMR) can help to rule in/out the diagnosis by providing additional information on myocardial structure, morphology, and kinetics of both ventricles and of the diverticulum itself. We report the case of a patient who arrived in the Emergency Department for an acute cerebrovascular ischemic event with embolic pattern, who underwent non invasive diagnostic tests in order to identify the etiology.

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.

Unexpected Findings of Regulatory Factor X6 Gene Mutation and Severe Hepatic Macrovesicular Steatosis in a Neonate with Congenital Left Ventricle Diverticulum: A Case Report.

Herein we present a case of a neonate with congenital left ventricular diverticulum (LVD), a rare anomaly, with an unusual course and unexpected findings. The neonate was born at 35 weeks in Namazi Hospital (Shiraz, Iran) and presented with a pulsatile umbilical mass immediately after birth. Based on multiple imaging modalities, the presence of a connection between the left ventricular apex and the umbilicus was confirmed. Percutaneous closure of LVD was unsuccessful. The patient's clinical course deteriorated after developing sepsis and multiorgan failure. The patient passed away before any corrective surgery could be performed. Unexpected findings in post-mortem evaluation were severe hepatic macrovesicular steatosis (suggestive of metabolic liver disease) and regulatory factor X6 (RFX6) heterozygous missense mutation in whole-exome sequencing.

Pentalogy of Cantrell with Pentalogy of Fallot and Left Ventricular Diverticulum

Pentalogy of Cantrell is a congenital anomaly characterized by a combination of birth defects involving the sternum, diaphragm, pericardium, abdominal wall, and heart. Pentalogy of Cantrell is a rare anomaly with high mortality. This paper describes the treatment of a 9-month-old girl with pentalogy of Cantrell, pentalogy of Fallot, and left ventricular diverticulum. The patient is alive and well 13 years after surgery.

Double chambered left ventricle-Two chambers are not better than one.

In this month's Journal,1 Ali and colleagues present a case series consisting of two adults who underwent surgical resection for a double chamber left ventricle (DCLV). The first case was an 18-year-old female with several years of progressive chest pain and dyspnea who was ultimately found to have both a double chamber right ventricle (DCRV) and DCLV after transthoracic echocardiography (TTE) and cardiac catheterization. She underwent surgical resection of the fibromuscular bands in both ventricles with an uncomplicated postoperative course. The second case was a 27-year-old male with a history of supravalvular aortic stenosis that had been previously addressed who on TTE was found to have aortic regurgitation, aortic stenosis, and DCLV with elevated left ventricular outflow tract and accessory chamber (AC) gradients. He underwent mechanical aortic valve replacement, ascending aorta replacement, and muscle bundle excision with a course notable for delayed sternal closure and retroperitoneal hematoma. Both patients had technically successful operations with band resection and appropriate biventricular function confirmed on TTE. Both survived their index operations and had resolution of their symptoms, with the second patient dying at 6 months due to complications from anticoagulation. The authors should be congratulated for the successful identification and operative treatment of these patients. DCLV is an incredibly rare diagnosis and is even less common than its counterpart DCRV—which is seen in less than 2% of all congenital cardiac anomalies.2 Ali and colleagues successfully differentiated DCLV from other similar pathologies such as left ventricular aneurysms and left ventricular diverticulum. This is critical given their difference in etiology and overall management. Those with asymptomatic DCLV do not require surgical intervention. Symptoms are rare but can present as fatal tachyarrhythmias or heart failure. Patients can also be found to have mid-ventricular obstructions, particularly those with superior–inferior arrangements according to Bao et al.3 Those who are intervened upon typically undergo resection with patch reconstruction or cardiac transplant for large communications.4 Furthermore, diagnosing DCLV can be a challenge in and of itself. Some patients, including the second case of this study, have previous imaging that does not confirm the presence of DCLV.5 This just reiterates the importance of having a high clinical suspicion. Nevertheless, TTE is typically the first test performed and serves as a fairly reliable starting point. Bao et al.3 showed that in their series of nine patients, eight were correctly diagnosed during their initial TTE. Although a tissue diagnosis would be the best confirmatory test, a second imaging modality is typically used to confirm the diagnosis. The authors used cardiac catheterization and magnetic resonance imaging (MRI) in their first and second case, respectively, as their second modality of choice. The advantages of cardiac MRI are stated throughout the literature. It offers high inherent contrast resolution, good spatial and temporal resolutions, a wide field of view, multiplanar imaging capabilities, and the absence of radiation.4, 6 Gadolinium is particularly useful as a similar enhancement of the AC wall compared to the remainder of the left ventricular myocardium supports the diagnosis of DCLV.7 We (Figure 1) commend the authors on their work with this complex patient population. Both cases presented were unique and challenging. The authors demonstrated the ability to address DCLV in addition to the patient's existing congenital abnormalities. Furthermore, they demonstrate the ability to do so through both a transaortic and transmitral approach. DCLV is an incredibly rare diagnosis, making it difficult to establish practice guidelines. One should always pause when deciding when and how to operate on these patients. Still, Ali and colleagues add to the body of literature that suggests operating on DCLV can be done safely and that patients may derive a meaningful benefit. This work was supported by a research grant from NHLBI/NIH (No. T32HL007849). The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health. The authors declare no conflict of interest.

Isolated Congenital Left Ventricular Diverticulum of the Fetal Heart in a Twin Pregnancy: Case Report and Literature Review

Isolated Congenital Left Ventricular Diverticulum of the Fetal Heart in a Twin Pregnancy: Case Report and Literature Review

Giant subaortic left ventricular diverticulum with aortic regurgitation and stenosis

A subaortic left ventricular diverticulum (SLVD) represents an extremely rare congenital anomaly. It can be asymptomatic but sometimes develops fatal complications. Treatment has been debated due to limited experience. We present the successful treatment of a giant SLVD with aortic regurgitation and stenosis and ascending aorta dilatation. Our goal is to improve understanding of this rare entity.

Prenatal diagnosis of accessory mitral valve tissue in a fetus with persistent dysrhythmia

BackgroundAccessory 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 presentationAMVT 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.ConclusionsThe diagnosis of AMVT in the prenatal period is possible by fetal echocardiography.

Echocardiographic features of left ventricular recess, cleft, diverticulum, and aneurysm: A systematic review.

A pouch protruding into the wall of the left ventricle (LV) may be either a recess, cleft, diverticulum, or aneurysm. Being aware of these anomalies is essential to make accurate diagnosis and guide management decisions. Standard multimodality imaging of the heart enables detailed characterizations of LV fissures and outpouchings. They often present as an incidental finding on echocardiography, and the clinical significance can be difficult to address. We provide an overview of echocardiographic features of LV recess, cleft, diverticulum, pseudoaneurysms/aneurysms, and non-compaction based upon review of the literature as well as present some relevant clinical cases from our echocardiography labs.

Experience in the Treatment of Pentalogy of Cantrell with Artificial Materials in a Single Clinical Center.

To summarize experience in the treatment of pentalogy of Cantrell (POC) in our hospital and explore the effect of artificial materials in repairing sternal defects. A retrospective analysis was performed on treatment of five children with POC treated by using the Gore-Tex patch and titanium mesh in the Department of Cardio-Thoracic Surgery, Children's Hospital of Chongqing Medical University, from January 2010 to January 2019. The concurrent conditions included double outlet of right ventricle (n = 2), ventricular septal defect (VSD) and atrial septal defect (ASD) (n = 1), VSD and ASD and patent ductus arteriosus (n = 1), and VSD and left ventricular diverticulum (n = 1) in five cases with POC. Color Doppler echocardiography and computed tomography (CT) + three-dimensional (3D) reconstruction of the thorax and abdomen were performed preoperatively. The cardiac malformation was corrected according to color Doppler echocardiography, and a Gore-Tex patch was used to repair the pericardial defect. Titanium mesh was made according to CT 3D reconstruction with a 3D printing mold to repair sternal defects. All patients underwent a one-stage operation, all hearts were eventually repositioned, no deaths occurred after the operation, and follow-up was performed for 6 months to 2 years. The patients recovered well, and the exterior thorax was normal. The diagnosis of POC is not difficult. The priority of surgical treatment for POC is to obtain satisfactory corrections of cardiac malformation. The repair of the pericardial defect with the Gore-Tex patch and the sternal defect with the titanium mesh can make the heart return to the mediastinum, reduce the pressure on the heart, reduce the surgical trauma, reduce the difficulty of repairing the sternal defect, and optimally restore the exterior thorax.

Fechamento transcateter de divertículo ventricular esquerdo congênito com dispositivo percutâneo em criança de 5 anos

Ventricular diverticulum is a rare congenital malformation. Although most patients are asymptomatic, it can present with rupture and sudden death, for which surgical repair is indicated. The authors report the case of a 5-year-old boy with a prenatal diagnosis of an isolated left ventricular diverticulum. It was decided for surgical closure; however, a persisting leakage at the patch repair site was observed, for which a transcatheter percutaneous closure approach was used, achieving complete occlusion of the defect. Transcatheter closure of suitable ventricular diverticula is a safe and effective option.

VP15.11: Pentalogy of Cantrell: a rare, not‐to‐be‐missed pathology in the first trimester

In 1958, Cantrell first described the full spectrum of Cantrell's Pentalogy (CP), an extremely rare and usually fatal disorder. The full spectrum includes five anomalies: an omphalocele, anterior diaphragmatic hernia, sternal cleft, cardiac ectopy, intracardiac defect (a ventricular septal defect or a left ventricular diverticulum). We report a case of Cantrell's Pentalogy. The patient is a 26 year-old female, without any notable pathological history. She's in a first degree consanguineous marriage. No similar case in the family was detected, gravida 2 para 1. The patient was referred to us at 12 weeks and 4 days since last menstrual period (LMP) for the detection of a heart in an extra-thoracic position. The ultrasound performed at 12 weeks and 4 days since LMP showed a progressive mono-fetal pregnancy in relation to the estimated date of delivery. The nuchal translucency measurement was normal. A poly-malformative syndrome accompanied by an omphalocele, a diaphragmatic hernia and a cardiac ectopy, was confirmed. No brain or extremity abnormalities were suspected. The patient benefited from a termination of the pregnancy and the anatomopathological examination confirmed the diagnosis. The reported case had three elements of Cantrell's Pentalogy. It is thanks to the ultrasound of the first trimester that we were able to diagnose this extremely rare pathology with an unfavourable prognosis.

OP05.09: First trimester diagnosis of cardiac diverticulum: two case reports of ventricular outpouching associated with pericardial effusion

The congenital cardiac outpouching is a rare abnormality in the fetus. Outpouching can be a diverticulum or an aneurysm. Diverticulum and aneurysm can be differentiated depending on the location, composition and contractility of the wall. The causative factor is a weakening of the ventricular wall, which can be due to embryogenesis defects, infections or local ischemia due to coronary anomalies. Cardiac diverticulum (CD) is more commonly detected from the second trimester. Very few cases are reported in first trimester. Sonographic presentations range from abnormal four-chamber view, arrhythmia, pericardial effusion to fetal hydrops. Generally, the prognosis of an isolated CD is excellent. We present two cases of isolated, congenital cardiac diverticulum diagnosed in the first trimester. Taking into account the site of origin and contractility of the outpouching we considered it to be a cardiac diverticulum. Left ventricular diverticulum diagnosed at Crown–rump length (CRL) of 45 mm. Right ventricular diverticulum at CRL of 76 mm. One case showed arrhythmia. Both cases were associated with large pericardial effusion. Both the pregnancies were terminated. The first trimester diagnosis of cardiac diverticulum is possible following a thorough cardiac examination. Pericardial effusion aids in the diagnosis of the diverticulum. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.