Left Ventricular Diverticulum Research Articles

Surgical treatment of congenital left ventricular diverticulum.

BackgroundCongenital left ventricular diverticulum (LVD) is a rare cardiac malformation. Its prevalence rate is less than 0.1% of the congenital heart diseases requiring surgery. Some scholars suggest that all LVD should be actively removed to prevent possible risks, including diverticulum rupture, arterial embolism, and malignant arrhythmia. However, others believe that asymptomatic LVD can be followed up without immediate surgery. We reviewed and reported the diagnosis, clinical features, and surgical treatment of four cases of congenital LVD to provide clinical experience and a reference for the treatment of such patients.MethodsFour patients (aged 3–32 years old) were diagnosed with congenital LVD and received surgical treatment at the Department of Cardiovascular Surgery of PLA General Hospital, Beijing, China from September 2009 to July 2019. All four patients had complete long-term postoperative follow-up data, including echocardiogram, enhanced cardiac computed tomography (CT), and electrocardiogram to monitor changes in left ventricular structure, heart function, and heart rhythm.ResultsIn the first case, the fibrodiverticulum under the aortic valve squeezed the right ventricular outflow tract and the right main coronary artery; the morphology of the right ventricle and coronary artery returned to normal after surgery. The second patient was complicated with a huge lipoma in the apex of the left ventricle and underwent lipoma resection during LVD resection surgery. The third and fourth cases had muscular diverticula in the left ventricular apexes and received LVD removal surgery. All four patients recovered well after surgery and their left ventricular morphology and cardiac function were normal without adverse complications, such as atrial fibrillation, ventricular arrhythmia, and cerebrovascular accident.ConclusionsAlthough the morphology and character of congenital LVD were different in each case, the use of effective diagnostic and follow-up tools, including echocardiogram, enhanced CT, and magnetic resonance imaging (MRI), allowed for successful surgical treatment of the left ventricular diverticula and symptoms or other malformations. We propose that congenital LVD should be actively treated with surgery, especially considering effectiveness and low risk associated with this therapeutic option.

Surgical Repair of Congenital Left Ventricular Diverticulum

Surgical Repair of Congenital Left Ventricular Diverticulum

Diagnosis of Double-chambered Left Ventricle of Superior-inferior Type by Echocardiography: A Retrospective Study of 9 Subjects across Two Heart Centers.

Double-chambered left ventricle (DCLV) is extremely rare. Challenges remain in accurate diagnosis of DCLV by echocardiography, because it is easily confused with left ventricular diverticulum, left ventricular aneurysm, ventricular septal defect, etc. Herein, we reviewed echocardiographic characteristics of DCLV and evaluated the accuracy of echocardiographic diagnosis. Clinical and echocardiographical databases of two heart centers were reviewed. Nine children with DCLV of superior-inferior arrangement were studied retrospectively. Normal elliptical geometry of LV cavity is preserved in DCLV. Fibromuscluar bundles separate LV into the main chamber and the accessory chamber. The associated malformations included ventricular septal defects, mitral regurgitation, mitral valve stenosis, pulmonary stenosis, and left ventricular noncompaction in our study. Eight of nine subjects with DCLV of superior-inferior arrangement were diagnosed correctly by initial echocardiographic examination, and one case was mistaken as left ventricular diverticulum. Double-chambered left ventricle could be diagnosed and followed up by echocardiography. The morphological classification is a simplified way to improve diagnostic accuracy.

Left ventricular diverticulum associated with two concealed atrioventricular accessory pathways.

A 27-year-old man with paroxysmal episodes of atrioventricular reciprocating tachycardia was referred for radiofrequency catheter ablation of a concealed atrioventricular accessory pathway (AP). Echocardiography revealed the presence of a finger-shaped inferior-basal left ventricular diverticulum (LVD), which was confirmed by CT scan (30 mm × 11 mm). The ablation procedure was performed using the CARTO3™ mapping system to identify the site of earliest retrograde atrial depolarization (ERAD) during ventricular pacing (cycle length = 400ms). This site corresponds to the atrial insertion of the AP. The resulting 3D map was merged with the CT-scan images (Panel B). The ERAD was located close to the tricuspid annulus, slightly lateral to the LVD projection (‘site 1’, Panel A). Radiofrequency application at site1 resulted in a significant increase (+40 ms) in the local stimulus-to-atrial-electrogram delay. A new 3D map was produced to verify the location of the ERAD, then located slightly septal...

Partial resection of large congenital left ventricular diverticulum in an infant: a case report

BackgroundCongenital left ventricular diverticulum is a rare cardiac malformation usually requiring total resection.Case presentationThis report describes an infant presenting with a large apical diverticulum with a wide ventricle connection. Given the vicinity of the left anterior descending coronary artery to the diverticulum and its wide ventricular connection, partial resection was undertaken. The patient remained asymptomatic with good heart function 8 months after surgery. The last follow-up echocardiography did not demonstrate any significant left ventricular outpouching.ConclusionsWe advocate early treatment of left ventricular diverticulum in children given the risk of spontaneous rupture of diverticulum, sudden death, and other serious complications if left untreated. For small patients with a wide connection of diverticulum to ventricle, partial resection is a safe option with favorable short-term outcomes.

Cardiac Diverticulum

Left ventricular diverticulum (LVD) is a rare clinical entity which contains endocardium, myocardium, and pericardium with normal contractility. Contrary to LV aneurysm, which has thin and fibrotic LV wall with paradoxical movement compared to normal left ventricle contraction. LVD are two types, that is, congenital or acquired. Congenital is more common than acquired form. Classification according to the location is either apical or nonapical. Apical diverticula usually associated with midline thoracoabdominal defects and other cardiac malformations, but nonapical diverticula were isolated. Nonapical diverticula can arise from the anterior-free wall, the subaortic region, or, rarely, from both ventricles. A diagnosis can be usually done by echocardiography, whereas computed tomography angiography, magnetic resonance imaging, and invasive ventriculography also help. A major problem with LVD is thrombosis, embolism, rupture, ventricular arrhythmias, congestive heart failure, and valvular abnormalities. The management of LVD depends on the clinical condition and associated abnormalities. In most asymptomatic person can be managed conservatively. Treatment for high-risk cases includes surgery, anticoagulants, and treatment of arrhythmias.

An Echocardiographic Guide to Distinguish a Rare Cardiac Abnormality: Case Study of Left Ventricular Diverticulum and Review of the Literature

The ventricular diverticulum is a rare cardiac condition with characteristics of a localized aneurysm from the cardiac chamber. This abnormality may exist either in isolation or with other cardiac defects. Clinically, patients with such a condition are often asymptomatic; however, fatal complications can arise.1 Diagnosis can be established by two-dimensional (2-D) echocardiography and supported by other diagnostic modalities. This article presents a case study with congenital left ventricular (LV) diverticulum from a 2-D echocardiographic approach and aims to guide cardiac sonographers to make an appropriate diagnosis from differential pathologies.

Diagnosis of congenital double-chambered left ventricle by Doppler echocardiography

Objective To review the imaging characteristics and evaluate the diagnostic value of echocardiography for congenital double-chambered left ventricle(DCLV) in children, and improve the diagnostic accuracy of initial echocardiography. Methods Doppler echocardiography was performed and these images were compared retrospectively with operative and computed tomography angiography findings in 8 children with DCLV. Results DCLV was characterized by the presence of a main left ventricular chamber and an auxiliary chamber seperated by abnormally hypertrophic muscle and/or fiber bundles. Six cases were diagnosed with type A, and 2 cases with type B by Li Jun′s classification. The associated malformations included ventricular septal defect (3 cases), mitral regurgitation (2 cases), mitral valve stenosis (1 case). Six of 8 cases(75.0%) were diagnosed correctly using Doppler echocardiography, in the remaining 2 cases (25.0%), 1 case was missed, 1 case misdiagnosed as left ventricular diverticulum. Conclusions DCLV could be correctedly diagnosed by Doppler echocardiography. This malformation should be differentiated from left ventricular diverticulum, left ventricular aneurysm, left ventricular non-compaction, and ventricular septal defect. Key words: Echocardiography, Doppler; Double-chambered left ventricle

Aortic Stenosis and Regurgitation with Aortic Subannular Left Ventricular Diverticulum and Occlusion of the Right Coronary Ostium by the Bicuspid Aortic Valve

Aortic Stenosis and Regurgitation with Aortic Subannular Left Ventricular Diverticulum and Occlusion of the Right Coronary Ostium by the Bicuspid Aortic Valve

P1094D CMR flow mapping and strain analysis of a muscular left ventricular diverticulum

P1094D CMR flow mapping and strain analysis of a muscular left ventricular diverticulum

Isolated congenital left ventricular diverticulum presenting as stable angina pectoris and surgical treatment.

Isolated congenital left ventricular diverticulum presenting as stable angina pectoris and surgical treatment.

A young male with cardiac arrest caused by ventricular tachycardia associated with left ventricular diverticulum

A young male with cardiac arrest caused by ventricular tachycardia associated with left ventricular diverticulum

Congenital left ventricular aneurysms and diverticula: an entity in search of an identity.

Congenital left ventricular aneurysm or diverticulum are rare cardiac malformations described in 809 cases since the first description in 1816, being associated with other cardiac, vascular or thoraco-abdominal abnormalities in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. In an experimental study, targeted knockdown of cardiac troponin T in the chick was performed at day 3, after the heart tube has formed. Morpholino treatment of gene TNNT2 at this stage led to the development of left ventricular diverticula (LVD) in the primitive left ventricular wall. Diagnosis of left ventricular aneurysms (LVA)/LVD can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most of LVA and LVD are asymptomatic or may cause systemic embolization, congestive heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies (echocardiography, magnetic resonance imaging or left ventricular angiography) visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection (especially in symptomatic patients), anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator (ICD) in case of symptomatic ventricular tachycardias, and occasionally combined with class I- or III-antiarrhythmic drugs. Cardiac death occurs usually in childhood, is significantly more frequent in LVA patients and caused by congestive heart failure in most of the cases, whereas patients diagnosed with LVD died more frequently from rupture of the LVD.

Early Detection of Left Ventricular Diverticulum by Transthoracic Echocardiography

Left ventricular diverticulum is a very rare entity to be found in adults. Noninvasive echocardiography can offer useful information prior to contrast-enhanced computer tomography or invasive angiography. We evaluated a patient with left ventricular apical diverticulum but complained no symptoms. Transthoracic echocardiography demonstrated a outpouching at left ventricle apex. A 640-slice computed tomography later confirmed the left ventricular diverticulum.

P2105Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: analysis of 809 cases published since 1816

P2105Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: analysis of 809 cases published since 1816

Isolated supravalvular aortic stenosis with left ventricular diverticulum and cleft mitral valve: Surgical repair in adulthood

Supravalvular aortic stenosis is an uncommon but well characterized congenital narrowing of the ascending aorta above the level of the coronary arteries. It can be a familial disorder, can occur sporadically, or can be associated with Williams syndrome. We are reporting a very rare presentation of supravalvular aortic stenosis with associated left ventricular diverticulum and cleft mitral valve. Repair consisted of resection of the ascending aorta, patch augmentation of the aortic root, and mitral valve repair. Follow-up echocardiography demonstrated normal mitral and aortic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.

An Interesting Case of Left Ventricular Diverticulum

Left ventricular (LV) diverticulum is defined as a protrusion of the free wall of the ventricle, including endocardium, myocardium, and pericardium. It is classified into fibrous and muscular types. Most of the patients are asymptomatic. It is mainly diagnosed by echocardiography, magnetic resonance imaging, and ventriculography. Surgery is the treatment of choice if the patient is symptomatic associated with other cardiac anomalies. In asymptomatic patient with isolated LV diverticulum, the treatment is controversial. Our patient is a 35-year-old male presented with progressive dyspnea on exertion for the past 1 month. Clinical examination was normal. His electrocardiogram revealed sinus tachycardia. There was no evidence of ischemic changes. Echocardiogram revealed aneurysmal outpouching of the posterolateral basal segment of the left ventricle adjacent to the posterior mitral leaflet [Figure 1]. Ejection fraction was 50% with trivial mitral regurgitation. His coronary angiogram showed normal epicardial coronaries. The patient was treated with furosemide, enalapril, metoprolol, and spironolactone. Then, the patient was referred to the cardiothoracic surgery department for further management.

Left ventricular diverticulum with ventricular premature complexes in fetal and postnatal period: A rare presentation

Congenital ventricular diverticulum is a rare congenital anomaly, which is defined as an outpouching structure that contains all the three layers of heart; that is, endocardium, myocardium, and pericardium and shows synchronous contractility. It remains clinically asymptomatic. The treatment of the left ventricular diverticulum (LVD) is undefined. We report a rare case of LVD presented as fetal bradycardia and further postnatally as ventricular premature complexes. A conservative approach with follow up was adopted in the case.

An Adult Case of Isolated Left Ventricular Large Diverticulum with Left Ventricular Systolic Dysfunction

An Adult Case of Isolated Left Ventricular Large Diverticulum with Left Ventricular Systolic Dysfunction

Case Report: Congenital left ventricular diverticulum: a pediatric case report

Congenital left ventricular diverticulum is a rare cardiac abnormality consisting of a localized outpouching from the free wall of the cardiac chamber. It is usually asymptomatic. However, complications such as infective endocarditis, arrhythmias, and embolism may occur. Medical ultrasound, echocardiography, CT angiography, MRI and invasive ventriculography are diagnostic tools used to identify congenital left ventricular diverticulum. Surgical resection is the treatment of choice in symptomatic patients, whereas the management of asymptomatic patients often represents a therapeutic dilemma. We report the case of a symptomatic left ventricular diverticulum on a 3-day-old female with Cantrell’s syndrome treated surgically. Postoperative course was uneventful. The patient was discharged with a good clinical condition. The prognosis of this malformation is poor if not diagnosed in the perinatal period. A diagnosis can be suspected with echocardiography; however, a CT scan allows a complete study of the problem. The treatment is always surgical with a good postoperative prognosis.