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Mvondo CM, Kengni HNT, Yon LCN, Ngandebe AAO, Sene E, Ngowe MN. Ventricular restoration in adults with huge congenital left ventricular aneurysm: report of two cases. Pan Afr Med J 2024; 48:8. [PMID: 38946742 PMCID: PMC11214139 DOI: 10.11604/pamj.2024.48.8.36988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 05/02/2024] [Indexed: 07/02/2024] Open
Abstract
Congenital ventricular aneurysms (CVA) are rare cardiac anomalies that have been predominantly described in the Black population. They are characterized by an akinetic ventricular protrusion that is commonly located at the basal and apical segments. Although the diagnosis is often incidental and the majority of patients are asymptomatic, life-threatening events such as persistent ventricular arrhythmias, CVA rupture, and heart failure are not uncommon. However, no standardized therapy is currently available and good outcomes have been reported with both conservative and surgical management. We report the cases of two young Black African patients with huge symptomatic CVA lesions who underwent successful surgical repair with a ventricular restoration technique. Both cases were consulted for chest pain and dyspnea. Chest X-ray and transthoracic Doppler echocardiography suggested the diagnosis. Thoracic angioscanner and thoracic magnetic resonance imaging confirmed the diagnosis. Both patients underwent successful surgery. This case report aims to revisit the diagnostic and therapeutic approach to this rare pathology, in our professional environment.
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Affiliation(s)
- Charles Mve Mvondo
- Division of Cardiac Surgery, Shisong Cardiac Centre, Kumbo, Cameroon
- Faculty of Medicine and Pharmacy, University of Douala, Douala, Cameroon
| | | | | | | | - Etienne Sene
- Department of Anesthesia and Intensive Care Unit, Fann University Hospital, Dakar, Senegal
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2
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Di Gioia G, Buzzelli L, Segreti A. Left ventricular inferior wall congenital diverticula in athletes: a case series and review of the literature. Eur Heart J Case Rep 2024; 8:ytae036. [PMID: 38313323 PMCID: PMC10834112 DOI: 10.1093/ehjcr/ytae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
Background Congenital left ventricular diverticula (LVDs) and aneurysms (LVAs) are rare, developmental, cardiac anomalies, which are often asymptomatic. Sometimes they can cause life-threatening complications like arrhythmias, syncope, embolic events, ventricular wall rupture, valvular regurgitation, congestive heart failure, and various symptoms. Diagnosis is usually made after exclusion of acquired causes, from cardiac or non-cardiac disorders. Specific guidelines for LVD/LVA management are not available and treatment options are guided by different case-by-case clinical presentation and possible complications. Case summary We present a series of two patients with occasional diagnosis of diverticula of the inferior basal left ventricular wall in the context of cardiological evaluations for competitive sport certificate. Symptoms were present at clinical evaluation only in Patient 1, together with electrocardiogram (ECG) abnormality. We performed transthoracic echocardiography as a first-line examination and secondly, we confirmed the diverticula by cardiac magnetic resonance. A maximal stress test and 24 h ECG Holter were also performed.In our case, in light of the clinical-instrumental findings, periodic medical and echocardiographic follow-up without therapy was established, together with the resumption of sports activities. Discussion Nowadays, no specific recommendations exist in athletes and no studies are available on how regular sport practice can influence natural history of LVD/LVA. The current case series highlights the importance of risk stratification for cardiac events, of a multimodal imaging approach in diagnostic procedure and of a tailored treatment strategy.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1–00197 Rome, Italy
- Department of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200–00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome ‘Foro Italico’, Piazza Lauro De Bosis, 15–00135 Rome, Italy
| | - Lorenzo Buzzelli
- Department of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200–00128 Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Sciences, Fondazione Policlinico Campus Bio-Medico, Via Alvaro del Portillo, 200–00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome ‘Foro Italico’, Piazza Lauro De Bosis, 15–00135 Rome, Italy
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3
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Infeld M, Nicoli CD, Khadanga S, VanBuren P, Correa de Sa DD. Congenital left ventricular wall defects presenting with ventricular arrhythmias: A case series. HeartRhythm Case Rep 2020; 6:715-719. [PMID: 33101939 PMCID: PMC7573374 DOI: 10.1016/j.hrcr.2020.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Margaret Infeld
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
- Address reprint requests and correspondence: Dr Margaret Infeld, Division of Cardiovascular Medicine, Department of Medicine, University of Vermont Larner College of Medicine, 111 Colchester Ave, McClure 1, University of Vermont Medical Center, Burlington, VT 05401.
| | - Charles D. Nicoli
- University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Sherrie Khadanga
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Peter VanBuren
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
| | - Daniel D. Correa de Sa
- Division of Cardiovascular Medicine, Department of Medicine, University of Vermont Larner College of Medicine, Burlington, Vermont
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Kobayashi Y, Kotani Y, Kuroko Y, Arai S, Kasahara S. Congenital left ventricular aneurysm diagnosed with atrial septal defect. Asian Cardiovasc Thorac Ann 2018; 27:404-406. [PMID: 30379565 DOI: 10.1177/0218492318811557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An 8-year-old girl with no history of chest pain or exertional dyspnea was admitted for atrial septal defect closure. Transthoracic echocardiography showed a sac in the right atrium, protruding from the left ventricle. A left ventricular aneurysm was confirmed by cardiac catheterization. At surgery, the protruding saccular aneurysm arising from the left ventricle was located between the atrial septal defect and the tricuspid valve. We closed the orifice with interrupted sutures from the right atrium. The atrial septal defect was closed with an autologous pericardial patch. Histology showed the aneurysmal wall had no myocardial layer, being replaced by fibrous tissue.
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Affiliation(s)
- Yasuyuki Kobayashi
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Kuroko
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Sadahiko Arai
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Bhardwaj B, Kumar SA, Webel R, Gautam S, Chockalingam A. Multimodality detection of multiple left ventricular diverticula: A case report and brief review of the literature. Echocardiography 2018; 36:184-188. [PMID: 30376597 DOI: 10.1111/echo.14179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022] Open
Abstract
Left ventricular diverticula (LVD) are rare congenital anomalies usually detected incidentally in the adult population. Most commonly, they are found as a single left ventricular diverticulum in association with other congenital abnormalities but multiple LVD are exceedingly rare. We are describing a patient who was found to have multiple LVD on multimodality imaging studies. He had presented with a sudden cardiac arrest attributed to a combination of alcohol intoxication and QT interval prolongation from hypokalemia and antidepressant medications. The patient was managed conservatively and discharged with an implantable loop recorder for detecting any occult arrhythmias.
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Affiliation(s)
- Bhaskar Bhardwaj
- Division of Cardiovascular Disease, Department of Medicine, University of Missouri- Columbia, Columbia, Missouri
| | - Senthil A Kumar
- Division of Cardiovascular Disease, Department of Medicine, University of Missouri- Columbia, Columbia, Missouri
| | - Richard Webel
- Division of Cardiovascular Disease, Department of Medicine, University of Missouri- Columbia, Columbia, Missouri
| | - Sandeep Gautam
- Division of Cardiovascular Disease, Department of Medicine, University of Missouri- Columbia, Columbia, Missouri
| | - Anand Chockalingam
- Division of Cardiovascular Disease, Department of Medicine, University of Missouri- Columbia, Columbia, Missouri
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6
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Koyak Z, de Groot JR, Bouma BJ, Zwinderman AH, Silversides CK, Oechslin EN, Budts W, Van Gelder IC, Mulder BJM, Harris L. Sudden cardiac death in adult congenital heart disease: can the unpredictable be foreseen? Europace 2017; 19:401-406. [PMID: 27247006 DOI: 10.1093/europace/euw060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/20/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Sudden cardiac death (SCD) is a major cause of mortality in adults with congenital heart disease (CHD). Several risk factors for SCD including conduction disturbances and ventricular dysfunction have been described previously. However, electrocardiogram (ECG) and echocardiographic parameters may change over time, and the predictive value of such temporal changes, rather than their point estimates, for SCD remains unknown. Methods and results This was a retrospective case-control study in adults with CHD and proven or presumed SCD and matched controls. Data were obtained from three databases including 25 000 adults with CHD. Sequential measurements were performed on electrocardiograms and echocardiograms. Ventricular function was assessed by echocardiography and graded on a four-point ordinal scale: 1, normal [ejection fraction (EF) ≥50%]; 2, mildly impaired (EF 40-49%); 3, moderately impaired (EF 30-39%); and 4, severely impaired (EF < 30%). Overall, 131 SCDs (mean age 36 ± 14 years, 67% male) and 260 controls (mean age 37 ± 13 years, 63% male) were included. At baseline, median QRS duration was 108 ms (range 58-168 ms) in SCDs and 97 ms (range 50-168 ms) in controls and increased over time at a rate of 1.6 ± 0.5 vs. 0.5 ± 0.2 ms/year in SCDs and controls, respectively (P = 0.011). QT dispersion at baseline was 61 ms (range 31-168 ms) in SCDs and 50 ms (range 21-129 ms) in controls. QT dispersion increased at a rate of 1.1 ± 0.4 ms/year in SCD victims and decreased at a rate of 0.2 ± 0.2 ms/year in controls (P = 0.004). Increase of QRS duration ≥5 ms/year was associated with an increased risk of SCD [OR 1.9, 95% confidence interval (CI) 1.1-3.3, P = 0.013]. Change from any baseline systemic ventricular function (normal, mild, or moderately impaired) to severe ventricular dysfunction over time was associated with the highest risk of SCD (OR 16.9, 95% CI 1.8-120.1, P = 0.008). Conclusion In adults with CHD, QRS duration and ventricular dysfunction progress over time. Progression of QRS duration and the rate of impairment of ventricular function served to identify those at increased risk of SCD.
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Affiliation(s)
- Zeliha Koyak
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Berto J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Candice K Silversides
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Erwin N Oechslin
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
| | - Werner Budts
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Isabelle C Van Gelder
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.,Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Louise Harris
- Department of Cardiology, Peter Munk Cardiac Center, Toronto Congenital Cardiac Center for Adults, and University of Toronto, Toronto, Canada
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Coexistence of congenital left ventricular aneurysm and prominent left ventricular trabeculation in a patient with LDB3 mutation: a case report. J Med Case Rep 2017; 11:229. [PMID: 28821295 PMCID: PMC5563034 DOI: 10.1186/s13256-017-1405-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background The coexistence of congenital left ventricular aneurysm and abnormal cardiac trabeculation with gene mutation has not been reported previously. Here, we report a case of coexisting congenital left ventricular aneurysm and prominent left ventricular trabeculation in a patient with LIM domain binding 3 gene mutation. Case presentation A 30-year-old Asian man showed paroxysmal sinus tachycardia and Q waves in an electrocardiogram health check. There were no specific findings in physical examinations and serological tests. A coronary-computed tomography angiography check showed normal coronary artery and no coronary stenosis. Both left ventricle contrast echocardiography and cardiac magnetic resonance showed rare patterns of a combination of an apical aneurysm-like out-pouching structure with a wide connection to the left ventricle and prominent left ventricular trabecular meshwork. High-throughput sequencing examinations showed a novel mutation in the LDB3 gene (c.C793>T; p.Arg265Cys). Conclusions Our finding indicates that the phenotypic expression of two heart conditions, congenital left ventricular aneurysm and prominent left ventricular trabeculation, although rare, can occur simultaneously with LDB3 gene mutation. Congenital left ventricular aneurysm and prominent left ventricular trabeculation may share the same genetic background.
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8
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Dwivedi A, Freedberg R, Donnino R, Vainrib A, Dodson JA, Saric M. Geriatric Presentation of Idiopathic Left Ventricular Aneurysm. CASE 2017; 1:84-87. [PMID: 30062251 PMCID: PMC6058218 DOI: 10.1016/j.case.2017.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Idiopathic left ventricular aneurysm is a rare diagnosis. Management and prognosis of idiopathic left ventricular aneurysms remain unknown. We describe a conservative management of an idiopathic left ventricular aneurysm in a geriatric patient.
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9
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Shafter AM, Mukherjee A, Sethi P, Pai RG. Use of Unique Doppler Flow-Pattern for the Diagnosis of Left Ventricular Diverticulum. Echocardiography 2016; 33:799-801. [DOI: 10.1111/echo.13164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ahmed M. Shafter
- Department of Cardiology; Dignity Health - St. Bernardine Medical Center and UCR School of Medicine; San Bernardino California
| | - Ashish Mukherjee
- Department of Cardiology; Dignity Health - St. Bernardine Medical Center and UCR School of Medicine; San Bernardino California
| | - Prabhdeep Sethi
- Department of Cardiology; Dignity Health - St. Bernardine Medical Center and UCR School of Medicine; San Bernardino California
| | - Ramdas G. Pai
- Department of Cardiology; Dignity Health - St. Bernardine Medical Center and UCR School of Medicine; San Bernardino California
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10
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Incidence and prognosis of ventricular arrhythmias in patients with congenital left ventricular aneurysms or diverticula. Am J Med 2015; 128:653.e1-6. [PMID: 25596522 DOI: 10.1016/j.amjmed.2015.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with congenital left ventricular aneurysms and diverticula may present with arrhythmia. The incidence of ventricular arrhythmias and the clinical outcome of these patients have not been reported to date. METHODS Among 250 consecutive patients with congenital left ventricular aneurysms and diverticula detected by echocardiography, the clinical outcome of patients who presented with ventricular arrhythmias or associated symptoms was investigated. RESULTS Of 250 patients with congenital left ventricular aneurysms and diverticula, 30 had ventricular arrhythmias or syncope at initial presentation. During a follow-up of 85 months, spontaneous ventricular tachycardia occurred in 17 of these patients (57%). Ventricular tachycardia was sustained in 13, with a monomorphic pattern in 9 patients. In 82% (11 patients), ventricular tachycardia was inducible during electrophysiologic testing. In 7 patients a sustained monomorphic ventricular tachycardia with a right bundle branch block pattern similar to the clinical tachycardia was induced. Twenty patients were treated with antiarrhythmic agents. Eleven patients received an implantable cardioverter defibrillator. Appropriate device discharges were observed in 73% during a follow-up of 61 months. One patient underwent surgical resection of a congenital left ventricular aneurysm. Three patients underwent successful catheter ablation for incessant ventricular tachycardia. Of these, 2 were free of any clinically relevant arrhythmia during follow-up. Three patients died (10, 41, and 89 months after initial presentation). In 2 of them, the cause of death was attributed to ventricular arrhythmia. CONCLUSION The clinical outcome of patients with congenital left ventricular aneurysms and diverticula and arrhythmia is variable. Clinical ventricular tachycardia in these patients is often monomorphic and usually inducible during electrophysiologic study, indicating a role for this test in risk stratification. Appropriate discharges are frequent in implantable cardioverter defibrillator recipients with congenital left ventricular aneurysms and diverticula.
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11
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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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12
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MacKenzie R. Negative T Waves Again. J Insur Med 2015; 45:113-116. [PMID: 27584848 DOI: 10.17849/insm-45-02-113-116.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An asymptomatic middle-aged man is found to have an abnormal ECG during routine life insurance applicant screening. Subsequent investigations reveal a rare cause for the applicant's ECG abnormality.
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13
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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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14
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Romagnoli A, Ricci A, Morosetti D, Fusco A, Citraro D, Simonetti G. Congenital left ventricular diverticulum: Multimodality imaging evaluation and literature review. J Saudi Heart Assoc 2014; 27:61-7. [PMID: 25544824 DOI: 10.1016/j.jsha.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/24/2014] [Accepted: 07/18/2014] [Indexed: 12/17/2022] Open
Abstract
Congenital ventricular diverticulum is a rare cardiac malformation. We present the case of a 57-year-old man who underwent cardiac catheterization for suspected unstable angina. No coronary artery disease was diagnosed and a left ventricular diverticulum was incidentally found. Coronary CT and cardiac MRI were performed in order to confirm the diagnosis of a muscular type diverticulum and to exclude a post-ischemic aneurysm.
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Affiliation(s)
- Andrea Romagnoli
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
| | - Aurora Ricci
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
| | - Daniele Morosetti
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
| | - Armando Fusco
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
| | - Daniele Citraro
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
| | - Giovanni Simonetti
- University Hospital "Tor Vergata", Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Viale Oxford 81, 00133 RomaItaly
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15
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Cresti A, Franci L, Picotti A. Huge left ventricular diverticulum simulating athlete's heart, a multimodality imaging study. Heart 2013; 99:1467-8. [PMID: 23680881 DOI: 10.1136/heartjnl-2013-303769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Alberto Cresti
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy.
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16
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Ferrari E, Van Steenberghe M, Namasivayam J, Berdajs D, Niclauss L, von Segesser LK. Feasibility of transapical aortic valve replacement through a left ventricular apical diverticulum. J Cardiothorac Surg 2013; 8:3. [PMID: 23294524 PMCID: PMC3575297 DOI: 10.1186/1749-8090-8-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 12/17/2012] [Indexed: 12/02/2022] Open
Abstract
Transapical aortic valve replacement is an established technique performed in high-risk patients with symptomatic aortic valve stenosis and vascular disease contraindicating trans-vascular and trans-aortic procedures. The presence of a left ventricular apical diverticulum is a rare event and the treatment depends on dimensions and estimated risk of embolisation, rupture, or onset of ventricular arrhythmias. The diagnosis is based on standard cardiac imaging and symptoms are very rare. In this case report we illustrate our experience with a 81 years old female patient suffering from symptomatic aortic valve stenosis, respiratory disease, chronic renal failure and severe peripheral vascular disease (logistic euroscore: 42%), who successfully underwent a transapical 23 mm balloon-expandable stent-valve implantation through an apical diverticulum of the left ventricle. Intra-luminal thrombi were absent and during the same procedure were able to treat the valve disease and to successfully exclude the apical diverticulum without complications and through a mini thoracotomy. To the best of our knowledge, this is the first time that a transapical procedure is successfully performed through an apical diverticulum.
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Affiliation(s)
- Enrico Ferrari
- Department of Cardiovascular surgery, CHUV, University Hospital of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland.
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Saedi S, Salehi A, Saedi T, Hashemi MJ. Association of left ventricular diverticula and sinus venosus atrial septal defect. CONGENIT HEART DIS 2012; 8:E145-8. [PMID: 22891918 DOI: 10.1111/j.1747-0803.2012.00711.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2012] [Indexed: 01/21/2023]
Abstract
Left ventricular diverticula are congenital anomalies and are not as rare as previously thought. In adults, cardiac diverticula are generally accidental findings during imaging modalities, but concomitant disorders might frequently coexist. The pathophysiology, management, prognosis, and natural history of cardiac diverticula remain poorly understood and controversial. Definite diagnosis is often challenging due to similarities in appearance to other more common anomalies such as aneurysms, pseudoaneurysms, endocarditis, cysts, and hypertrophied trabeculations. We herein report a rare case of an adolescent presenting with sinus venosus atrial septal defect, partial anomalous venous connection, and left ventricular diverticula.
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Affiliation(s)
- Sedigheh Saedi
- Cardiology, Rajaee Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Arrhythmic manifestations in patients with congenital left ventricular aneurysms and diverticula. Am J Cardiol 2011; 108:1826-30. [PMID: 21943939 DOI: 10.1016/j.amjcard.2011.07.056] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Revised: 07/21/2011] [Accepted: 07/21/2011] [Indexed: 11/23/2022]
Abstract
Congenital left ventricular aneurysms and diverticula (LVA/Ds) are rare cardiac malformations that can be detected using echocardiography or other imaging techniques. Some of these patients present with ventricular arrhythmias. This study investigated clinical characteristics of patients with congenital LVA/D presenting with arrhythmic manifestations. Over the previous 20 years 250 patients were diagnosed to have congenital LVA/D at our institution. Diagnosis was made using echocardiography after exclusion of coronary artery disease, local cardiac inflammatory processes, traumatic causes, or cardiomyopathies. At initial presentation 32 of the 250 patients (13%, average age 45 years, range 25 to 65, 21 men and 11 women) exhibited arrhythmias. At least 2 LVA/Ds were present in 6 of these patients. LVA/Ds were localized at the posterobasal, apical, anteroseptal, and anterolateral walls in 12, 11, 4, and 5 patients, respectively. The most common complaints at presentation were syncope or presyncope in 18 patients and palpitations in 11 patients. One patient had survived sudden cardiac death. Long-term electrocardiographic recordings showed ventricular tachycardia (VT) or ventricular fibrillation in 17 patients (53%). Twelve patients underwent electrophysiologic testing. Nine patients had inducible ventricular tachyarrhythmia, whereas induced tachycardia was similar to that during spontaneous arrhythmia in 7 patients. In conclusion, patients with congenital LVA/Ds who present with arrhythmic manifestations commonly have VT. Electrophysiologic testing can reproduce clinical VT in most of these patients.
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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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Abstract
We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.
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Ohlow MA, Fuhrmann JT, Lauer B. Prevalence and spectrum of coronary artery anomalies in patients with an isolated congenital left ventricular aneurysm or diverticulum. Clin Cardiol 2011; 34:226-32. [PMID: 21319171 DOI: 10.1002/clc.20875] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 11/17/2010] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies and frequently associated with other cardiac anomalies. The objective of our study was to investigate the prevalence and the spectrum of coronary anomalies in such patients. HYPOTHESIS The incidence of coronary anomalies is increased in patients with LVA or LVD. METHODS We assessed 117 patients with isolated LVA or LVD for the prevalence of coronary anomalies and compared the findings with an age- and sex-matched control group (n = 117) without the diagnosis of LVA or LVD. RESULTS Coronary anomalies were present in 58.1% of the study population (68 of 117). The median age of affected patients was 64 years, and 45 (38.5%) were male. Coronary anomalies were more prevalent in patients with LVA or LVD (58.1% vs 6.8%, P < 0.001), male patients (89% vs 57%, P = 0.0002), and in patients with nonapical location of LVA or LVD (24% vs 45%, P = 0.02) compared with control, whereas age and type (LVA vs LVD) had no influence (57% vs 57.6%, P = 0.4; and 58.8% vs 57.6%, P = 0.87, respectively). The number of adverse cardiac events was similar in both groups during a 4.2-year follow-up period (29% vs 19%, P = 0.09). None of the patients in our series had major coronary anomalies with potential lethal consequences. CONCLUSIONS This large single-center study suggests that the prevalence of abnormal coronary-artery anatomy in patients with isolated LVA or LVD is as high as 58.1%. However, we did not identify major coronary anomalies with potential lethal consequences, and the clinical course during follow-up was not influenced by the presence or absence of coronary anomalies.
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Gorgels APM. No value of the ECG in congenital left ventricular aneurysms and diverticula? Europace 2010; 11:1577-8. [PMID: 19933773 DOI: 10.1093/europace/eup391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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