Fetal diagnosis of an "extra cardiac chamber"

Prenatal diagnosis of fetal right congenital ventricular aneurysms: An analysis of three cases and literature review

Right ventricular aneurysm is a rare congenital defect that can be diagnosed with fetal echocardiography. Information on etiology of right ventricular aneurysm is limited and its prognosis remains variable from asymptomatic forms to severe cases. Here we report three cases of fetal right ventricular aneurysms that could have been related to coronary artery disorders and needed regular monitoring of progression in size and signs of cardiac decompensation.

Autopsy and postnatal follow-up of prenatally diagnosed ventricular outpouchings

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.

Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature

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.

Congenital ventricular diverticulum and MI - Diagnostic challenges and implications

The use of modern cardiac imaging techniques suggests that congenital ventricular diverticulum (CVD) may be more common than generally believed and may present asymptomatically in adult life. We present a case of congenital left ventricular diverticulum diagnosed in a patient presenting with myocardial infarction (MI). The case highlights the importance of the differential diagnosis of CVD from post infarct left ventricular aneurysms (PILVA) and suggests that adult studies using modern imaging techniques are needed to define the prognosis for asymptomatic CVD in order to guide management.

Anterosuperior diverticula of the right ventricle: morphological spectrum and long-term outcome of a distinct cardiac anomaly

Right-ventricular diverticula (RVD), although rare, have particular characteristics. Our study describes the morphology of anterosuperior diverticula of the right ventricle (RV) and patient outcome for this anomaly. Retrospective analysis was performed on all patients with anterosuperior RVD diagnosed in two tertiary referral centres. From January 1982 to December 2012, five patients were diagnosed with anterosuperior RVD (median 4 months). Four patients had perimembranous ventricular septal defects (VSDs) with no clinical symptoms related to RVD. Communication of the RVD with the RV was located either close to the VSD (two patients) or in the anterior free wall of the RV opposite the VSD (two patients). In the remaining patient, the diverticulum was connected with the left ventricle (LV) by a tunnel-like structure originating from the left-ventricular outflow tract; the RVD communicated with the RV by way of a restrictive opening. Four patients underwent surgical repair including patch closure of the VSD (one patient) and patch closure of the VSD through an incision of the RVD followed by plication of the diverticulum or closure of its communication with the RV (three patients). All patients remained asymptomatic during a median follow-up of 14.8 years. Anterosuperior RVD is a specific congenital cardiovascular anomaly frequently associated with additional congenital heart disease. There are significant variations in how the RVD communicates with the RV with each requiring a different surgical repair strategy. According to the experience in our small cohort, the long-term prognosis of patients with anterosuperior RVD appears excellent after surgical correction of associated congenital heart disease.

Modified damus-kaye-stansel/dor procedure for a newborn with severe left ventricular aneurysm

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.

Fetal right ventricular diverticulum with pericardial effusion: report of a new case treated by in utero pericardiocentesis

Right ventricular diverticulum associated with pericardial effusion was diagnosed in a male fetus at 13 weeks of gestation. Screening for infectious, chromosomal, or structural disease was negative. Because there was concern about pulmonary hypoplasia, fetal pericardiocentesis was performed at 17 weeks of gestation. The pericardial fluid did not reaccumulate, and the diverticulum decreased and finally disappeared before the third trimester. The diverticulum could not be seen on the neonatal echocardiography scan performed on the full-term live baby, who was delivered vaginally. The child is doing well at 11 months of age. Given the good outcome of this case, in utero drainage should be considered in similar cases.

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.

Left ventricular accessory chamber: a case report and review of the literature

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.

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.