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Shuplock JM, Kavanaugh-McHugh A, Parra D. Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature. Pediatr Cardiol 2020; 41:272-281. [PMID: 31728571 DOI: 10.1007/s00246-019-02252-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
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.
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Affiliation(s)
- Jacqueline M Shuplock
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA.
| | - Ann Kavanaugh-McHugh
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA
| | - David Parra
- Thomas P. Graham Jr. Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN, 37232, USA
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Duong PH, Annavarapu S, Moran P, McBrien A. Fetal right ventricular aneurysm caused by chronic progressive myocardial ischemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:540-541. [PMID: 28150421 DOI: 10.1002/uog.17427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/08/2017] [Accepted: 01/28/2017] [Indexed: 06/06/2023]
Affiliation(s)
- P H Duong
- Paediatric Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle, Upon Tyne, NE7 7DN, UK
| | - S Annavarapu
- Paediatric Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle, Upon Tyne, NE7 7DN, UK
| | - P Moran
- Paediatric Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle, Upon Tyne, NE7 7DN, UK
| | - A McBrien
- Paediatric Cardiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, High Heaton, Newcastle, Upon Tyne, NE7 7DN, UK
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Ohlow MA, von Korn H, Lauer B. Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816. Int J Cardiol 2015; 185:34-45. [PMID: 25782048 DOI: 10.1016/j.ijcard.2015.03.050] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. METHODS MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. RESULTS We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04). CONCLUSIONS LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.
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Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany.
| | - Hubertus von Korn
- Medizinische Klinik I, Krankenhaus Hetzelstift, Neustadt/Weinstrasse/Weinstrasse, Germany
| | - Bernward Lauer
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany
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Peters C, Wacker-Gussmann A, Strasburger JF, Cuneo BF, Gotteiner NL, Gulecyuz M, Wakai RT. Electrophysiologic features of fetal ventricular aneurysms and diverticula. Prenat Diagn 2014; 35:129-36. [PMID: 25284224 DOI: 10.1002/pd.4501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 06/03/2014] [Accepted: 09/21/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Congenital ventricular wall defects are very rare and include congenital ventricular aneurysms (CVAs) and diverticula (CVDs). METHOD 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Carli Peters
- Department of Medical Physics, University of Wisconsin, Madison, WI, USA
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Malakan Rad E, Awad S, Hijazi ZM. Congenital left ventricular outpouchings: a systematic review of 839 cases and introduction of a novel classification after two centuries. CONGENIT HEART DIS 2014; 9:498-511. [PMID: 25159202 DOI: 10.1111/chd.12214] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis. OBJECTIVES The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs. DATA SOURCES We performed three separate sets of search on three subjects including "congenital left ventricular outpouchings," "important and simply measurable markers of left ventricular function," and "relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV." STUDY ELIGIBILITY CRITERIA We enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS We studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification. RESULTS A total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced. CONCLUSION The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.
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Affiliation(s)
- Elaheh Malakan Rad
- Section of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Hirose A, Maeno Y, Suda K, Fusazaki N, Kado H, Matsuishi T. Serial hemodynamic assessment using Doppler echocardiography in a fetus with left ventricular aneurysm presented as fetal hydrops. J Perinatol 2013; 33:486-9. [PMID: 23719251 DOI: 10.1038/jp.2012.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 22-week fetus presented with a large left ventricular aneurysm, 24 × 21 × 18 mm in size, detected by abnormal four-chamber view, and severe fetal hydrops with pericardial effusion, ascites and skin edema. The aneurysm was thin-walled, hypokinetic, and had enlarged with gestational age, causing compression of the lung. Although the left ventricular function had progressively impaired as expressed by increase in Tei index, hydrops had resolved by 32 weeks of gestation, probably because of maternal digoxin therapy and successful compensation by the right ventricle, as represented by retrograde blood flow in the distal aortic arch via the patent arterial duct. Because of the significant risk of severe cardiorespiratory failure, we transported the mother to a neonatal cardiac surgical center at 38 weeks of gestation. Indeed, the baby showed severe cardiopulmonary failure after birth, showing 100% of cardiothoracic ratio on the chest X-ray film, but was saved by the successful Dor procedure, including surgical resection of the aneurysm at 10 h of life. In this case, serial echocardiographic evaluation can allow us to monitor the hemodynamics and lead to successful postnatal management.
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Affiliation(s)
- A Hirose
- Division of Neonatology, Maternal and Perinatal Medical Center, Department of Pediatrics, Kurume University School of Medicine, Kurume, Japan.
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Seo DM, Won HS, Ko JK, Jhang WK. Modified damus-kaye-stansel/dor procedure for a newborn with severe left ventricular aneurysm. Korean Circ J 2011; 41:494-6. [PMID: 21949538 PMCID: PMC3173674 DOI: 10.4070/kcj.2011.41.8.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/29/2010] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Dong-Man Seo
- Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
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Weichert J, Chiriac A, Axt-Fliedner R. Fetal diagnosis of left ventricular aneurysm of the free wall and the interventricular septum: report of two cases and review of the literature. J Matern Fetal Neonatal Med 2010; 23:1510-5. [DOI: 10.3109/14767051003678127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Grethel EJ, Hornberger LK, Farmer DL. Prenatal and postnatal management of a patient with pentalogy of Cantrell and left ventricular aneurysm. A case report and literature review. Fetal Diagn Ther 2007; 22:269-73. [PMID: 17369693 DOI: 10.1159/000100788] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2006] [Accepted: 06/07/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Omphalocele is often associated with cardiac diverticulum in the pentalogy of Cantrell, however a prenatal diagnosis of omphalocele has not been described with a broad-based, thin-walled aneurysm of the ventricular wall in a surviving patient. CASE REPORT A case of omphalocele with Morgagni hernia and left ventricular aneurysm diagnosed at 21 weeks, 6 days' gestational age is reported. Initial ultrasound examination demonstrated the cardiac defect and subsequent ultrasounds revealed the abdominal wall defect. Prenatal monitoring included serial ultrasound and echocardiography. A viable fetus was delivered via cesarean section at 37 weeks' gestational age. The omphalocele and Morgagni hernia were repaired on the infant's 4th day of life. The cardiac defect continues to be monitored with echocardiography at 15 months of age. DISCUSSION The case is discussed along with a short review of the literature of midline thoracoabdominal defects and left ventricular apical aneurysms.
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MESH Headings
- Abdominal Wall/abnormalities
- Abdominal Wall/diagnostic imaging
- Adult
- Cesarean Section
- Female
- Fetal Diseases/diagnosis
- Fetal Diseases/diagnostic imaging
- Gestational Age
- Heart Aneurysm/congenital
- Heart Aneurysm/diagnosis
- Heart Aneurysm/diagnostic imaging
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/embryology
- Heart Ventricles/abnormalities
- Heart Ventricles/diagnostic imaging
- Hernia, Diaphragmatic/diagnosis
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Umbilical/diagnosis
- Hernia, Umbilical/diagnostic imaging
- Hernia, Umbilical/embryology
- Hernias, Diaphragmatic, Congenital
- Humans
- Live Birth
- Syndrome
- Ultrasonography, Prenatal
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Affiliation(s)
- Erich J Grethel
- Fetal Treatment Center, University of California, San Francisco, Calif. 94143-0570, USA.
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Ohlow MA. Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment. Cardiology 2006; 106:63-72. [PMID: 16612072 DOI: 10.1159/000092634] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation; 411 cases have been reported since its first description in 1816, and other cardiac, vascular or thoraco-abdominal abnormalities have been shown in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic or may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies such as 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; treatment options include surgical resection especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator in case of symptomatic ventricular tachycardia, occasionally combined with class I or III antiarrhythmic drugs.
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El Kady D, Gerscovich EO, Moon-Grady A, Towner D, McGahan JP, Rhee-Morris L, Naderi S. Congenital cardiac left ventricular aneurysm with pericardial effusion: early prenatal diagnosis and intervention. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1011-5. [PMID: 15972717 DOI: 10.7863/jum.2005.24.7.1011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Dina El Kady
- Department of Obstetrics and Gynecology, Division of Maternal and Fetal Medicine, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Prefumo F, Bhide A, Thilaganathan B, Carvalho JS. Fetal congenital cardiac diverticulum with pericardial effusion: two cases with different presentations in the first trimester of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 25:405-408. [PMID: 15747330 DOI: 10.1002/uog.1855] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Two cases of fetal congenital cardiac diverticula diagnosed at 14 and 12 weeks of gestation are reported. Both presented with a large pericardial effusion. One fetus presented with increased NT which evolved into fetal hydrops. Pericardiocentesis at 16 weeks led to progressive resolution of hydrops. The other showed no hemodynamic compromise, normal nuchal translucency (NT) and spontaneous regression of the effusion. Both children were well at 22 and 17 months of age at the time of writing.
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Affiliation(s)
- F Prefumo
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK
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Pipitone S, Sperandeo V, Mongiovi M, Roberto G, Centineo G. Prenatal diagnosis of ventricular aneurysm: a report of two cases and a review. Prenat Diagn 2002; 22:131-6. [PMID: 11857619 DOI: 10.1002/pd.259] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ventricular aneurysms have rarely been reported prenatally. Their prognosis is variable depending on factors such as early detection, their relative size in comparison to the ventricular cavity, growth on follow-up, and signs of cardiac failure. In view of the fact that it may be useful to report on additional cases in order to make available further information on aetiology, prognosis and neonatal management, we hereby report on two cases of ventricular aneurysm with good mid-term prognosis. One case of apical aneurysm of the left ventricle was associated with a muscular ventricular septal defect, the features of which are compatible with a fetal myocardial infarction and ventricular septal rupture in absence of coronary artery anomalies as demonstrated by catheterisation. Another case of sub-tricuspidal aneurysm of the right ventricle associated with mitral prolapse appears to be a component of diffuse connective dysplasia. Despite the early gestational age at diagnosis, the large size of the aneurysm and the associated defect, both the infants were asymptomatic in infancy prompting a conservative management.
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Papagiannis J, Van Praagh R, Schwint O, D'Orsogna L, Qureshi F, Reynolds J, Kallfelz C, Nozar J. Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases. Am Heart J 2001; 141:491-9. [PMID: 11231449 DOI: 10.1067/mhj.2001.113076] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Congenital left ventricular aneurysm is a poorly understood and potentially lethal entity. Methods and Results In a clinicopathologic study of 7 new cases, the major presenting features in 6 patients were congestive heart failure in 4, ventricular arrhythmias in a 32-week fetus, and multiple congenital anomalies in a fetus with trisomy 13. Accurate diagnosis was achieved in all 3 living patients by echocardiography, angiocardiography, and magnetic resonance imaging. The aneurysm was predominantly apical in 3 and involved most of the left ventricular free wall in 4. Of the 3 living patients, medical management alone sufficed in 2. The third, a newborn boy, underwent a new and successful aneurysm-exclusion left ventriculoplasty. The mitral valve was abnormal in all 4 autopsied cases, the papillary muscles being short, thin, or absent. The aneurysm was thinner and its area was larger than that of the nonaneurysmal left ventricle in all necropsied patients. CONCLUSIONS Congenital left ventricular aneurysm appears to be a developmental anomaly, an idiopathic dysplasia of left ventricular endocardium and myocardium. No evidence of a viral etiology was found. Some neonates can be managed medically, but others require urgent surgical intervention. A new surgical operation is presented, a functional left ventricular aneurysmectomy that minimizes intraoperative and postoperative blood loss and that preserves the coronary arteries.
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Affiliation(s)
- J Papagiannis
- Department of Pathology, Children's Hospital, 300 Longwood Ave., Boston, MA 02115, USA
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