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Abstract
Cardiac outpouchings pose a diagnostic challenge when encountered in practice, as the signs, symptoms, and initial investigations, such as radiographs and electrocardiogram, are nonspecific. They may remain asymptomatic and be incidentally detected. However, a few may present with progressive shortness of breath, thromboembolic complications, arrhythmias, pressure effects, rupture, or even death. Imaging is of paramount importance in establishing an accurate diagnosis, delineating morphology and extent of the lesion along with its hemodynamic significance, planning management, and in the follow-up.
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Abdissa S, Nega B, Goshu D. Submitral left ventricular aneurysm: Characteristics, diagnosis, management, and outcome. JOURNAL OF CLINICAL SCIENCES 2019. [DOI: 10.4103/jcls.jcls_99_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Congenital Ventricular Diverticulum or Aneurysm: A Difficult Diagnosis to Make. Case Rep Cardiol 2018; 2018:5839432. [PMID: 30534448 PMCID: PMC6252185 DOI: 10.1155/2018/5839432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 10/08/2018] [Indexed: 01/17/2023] Open
Abstract
A pouch protruding from the free wall of the left ventricle may be either a congenital ventricular diverticulum (CVD) or aneurysm (CVA). Being aware of these rare congenital anomalies is critical in making the diagnosis. Differentiating the two is important for treatment decisions. We describe a patient with dextrocardia, Tetralogy of Fallot, and a congenital left ventricular apical diverticulum diagnosed following the induction of anesthesia. CVD and CVA may present in the antenatal period through late adulthood with differing morphology, location, and symptoms. Echocardiography is paramount in the diagnosis and characterization of these lesions. If this anomaly is encountered after the induction of anesthesia or during intraoperative echocardiography, the cardiothoracic anesthesiologist should make the surgical team aware so it can be further characterized and a treatment plan made prior to incision.
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Cresti A, Cannarile P, Aldi E, Solari M, Sposato B, Franci L, Limbruno U. Multimodality Imaging and Clinical Significance of Congenital Ventricular Outpouchings: Recesses, Diverticula, Aneurysms, Clefts, and Crypts. J Cardiovasc Echogr 2018; 28:9-17. [PMID: 29629254 PMCID: PMC5875147 DOI: 10.4103/jcecho.jcecho_72_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The high spatial resolution of cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) permit the diagnosis of congenital ventricular outpouchings (CVOs), including congenital ventricular diverticula (CVD), congenital ventricular aneurysms (CVA), clefts, and crypts. A unique classification has not been established, and these terms are used interchangeably with confounding terminology. Moreover, their significance is not univocal. A research was performed using PubMed on six subjects: (1) congenital left ventricular outpouchings; (2) congenital ventricular diverticulum; (3) congenital ventricular aneurysm; (4) ventricular clefts; (5) ventricular crypts; and (6) ventricular crevices. Usually, CVOs are small with a preserved contraction and in asymptomatic patients, the clinical relevance may be minimal, although electrocardiographic anomalies are often present. CVA and diverticula may carry an embolic risk and cases of arrhythmia and rupture are described. In the presence of clefts, or crypts a cardiomyopathy should be excluded. A simple classification can be proposed: CVD extend beyond the myocardial wall and fibrous type may be termed CVA, acquired forms should be kept distinct. Clefts, or crypts, are small recesses extending for more than 50% of the ventricular wall but not beyond its margin. The presence of fibrosis may be evaluated by CMR. A multicenter prospective registry would be helpful to investigate potential clinical implications and to exclude dubious forms of hypertrophic cardiomyopathy or ventricular noncompaction. In conclusion, CVOs have been described with different terminologies and classifications. Their significance needs to be interpreted in the clinical setting and with the help of a multimodality imaging, particularly of CMR.
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Affiliation(s)
- Alberto Cresti
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | | | - Elena Aldi
- Department of Radiology, University of Siena, Siena, Italy
| | - Marco Solari
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
| | - Bruno Sposato
- Department of Internal Medicine, Misericordia Hospital, Grosseto, Italy
| | - Luca Franci
- Department of Radiology, Misericordia Hospital, Grosseto, Italy
| | - Ugo Limbruno
- Department of Cardiology, Misericordia Hospital, Grosseto, Italy
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Wang L, Cao X, Xue J, Li H, Shi L, Men Y. Echocardiographic features of right ventricular diverticulum: A case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:531-534. [PMID: 28880385 DOI: 10.1002/jcu.22445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/27/2016] [Accepted: 11/25/2016] [Indexed: 06/07/2023]
Abstract
Right ventricular diverticulum is a rare form of cardiac deformity, with a very few cases caused by pericarditis. A 60-year-old man sought medication because of chest congestion and shortness of breath. CT showed a soft tissue mass at the heart apex and pericardial calcification. Doppler echocardiography demonstrated a mixed cystic solid mass at the right ventricular apex. Surgical cure confirmed the diagnosis of right ventricular apex diverticulum with pericarditis. Echocardiography is contributive to the diagnosis of ventricular diverticula in measuring their size and showing the local thinning of the ventricular wall with localized bulging and abnormal motion. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:531-534, 2017.
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Affiliation(s)
- Lihong Wang
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
| | - Xiaoli Cao
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
| | - Jie Xue
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
| | - Hongyan Li
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
| | - Lei Shi
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
| | - Yanming Men
- Department of Ultrasonography, Yantai Yuhuangding Hospital, 20 Yuhuangding East Road, Yantai, Shandong, 264000, China
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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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Ling Y, Li D, An Q. Successful perventricular device closure of cardiac diverticulum in an infant. Int J Cardiol 2014; 177:e170-1. [PMID: 25201026 DOI: 10.1016/j.ijcard.2014.08.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/21/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Yunfei Ling
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Dongxu Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
| | - Qi An
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Sichuan, People's Republic of China
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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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Ozturk E, Saglam M, Sivrioglu AK, Kara K. Left ventricular clefts and diverticula. Eur J Radiol 2013; 82:e628. [PMID: 23891297 DOI: 10.1016/j.ejrad.2013.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 07/04/2013] [Indexed: 11/16/2022]
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Dwivedi AND, Thangiah AG, Rai M, Tripathi S. Computed tomographic features of congenital left ventricular diverticulum. J Clin Imaging Sci 2012; 2:48. [PMID: 22919562 PMCID: PMC3424775 DOI: 10.4103/2156-7514.99182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 06/17/2012] [Indexed: 02/05/2023] Open
Abstract
Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized out-pouching from the cardiac chamber. They are most often found in the left ventricle (LV) but have been reported to occur in all chambers of the heart. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture may be the initial presentation. Diagnosis can be established by echocardiography (EKG), computed tomographic (CT) angiography, and magnetic resonance imaging (MRI). We report a case of congenital left ventricular diverticulum in an adult with no valvular abnormality as an incidental finding in an uncommon location.
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Affiliation(s)
- Amit N D Dwivedi
- Deptartment of Radiodiagnosis and Imaging, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
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11
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Left and right ventricular diverticula: incidence and imaging findings on 256-slice multidetector computed tomography. J Thorac Imaging 2012; 27:179-83. [PMID: 21516044 DOI: 10.1097/rti.0b013e31821255ae] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac ventricular diverticulum is a rare congenital malformation. The entity is usually asymptomatic but can rarely cause complications and mimic other severe cardiac diseases on imaging. We evaluated the incidence and imaging findings of left and right ventricular diverticula on electrocardiogram-gated 256-slice multidetector computed tomography angiography (MDCTA). MATERIALS AND METHODS We reviewed 324 patients (188 men; 136 women; mean age, 56 ± 15 y; age range, 7 to 91 y) who underwent retrospective (n=177) or prospective (n=147) electrocardiogram-gated cardiac CTA using a 256-slice MDCT scanner (Brilliance iCT, Phillips Healthcare; slice collimation, 2 × 128 × 0.625 mm; gantry rotation time, 270 ms) and searched for ventricular diverticula. We evaluated the incidence, size, location, and CT findings of the ventricular diverticula on the MDCTA images. RESULTS Eighteen ventricular diverticula were detected in 11 patients (incidence, 3.4%; 3 men; 8 women). Fifteen left ventricular diverticula were detected in 11 patients (incidence, 3.4%), and 3 right ventricular diverticula were found in 2 patients (incidence, 0.6%). The left ventricular diverticula were commonly located in the mid-inferoseptal (n=6) and mid-anteroseptal (n=4) walls. The right ventricular diverticula were located in the apical inferoseptal, mid-anteroseptal, and mid-inferoseptal walls. The mean maximal diameter of ventricular diverticula was 10 ± 3 mm (range, 7 to 16 mm). Multiple diverticula were seen in 5 patients (45%) and were commonly found clustered close to one another. Each of 13 ventricular diverticula with images obtained both in systole and diastole showed synchronous contraction with adjacent myocardium, and 4 diverticula completely closed in systole. CONCLUSIONS The incidence of left and right ventricular diverticula on 256-slice MDCTA was 3.4% and 0.6%, respectively, an incidence more frequent than in previous reports. The ventricular diverticula were commonly located in the mid-inferoseptal or mid-anteroseptal wall.
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Nikolov D, Grigorova V, Kirova G, Keltchev A. Rare diagnosis of fibrous cardiac diverticulum in an adult followed by urgent surgical intervention. Interact Cardiovasc Thorac Surg 2012; 15:563-5. [PMID: 22685025 DOI: 10.1093/icvts/ivs261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We describe the case of a 59-year old male patient with an acute onset of chest pain who was admitted to our unit with a suspected rupture of the left ventricle pseudoaneurysm, compressing the left atrium and the ascending aorta. Our urgent surgical intervention caused us to reject our initial diagnosis and revealed a cardiac diverticulum arising from the left ventricle outflow tract, spreading to the sub-valvular area compressing the left atrium, the ascending aorta and the pulmonary trunk, and compromising the aortic and mitral valve, causing moderate regurgitation. We removed the defect and replaced the aortic valve, eliminating the compression of the left atrium, aorta and pulmonary trunk. This article discusses the surgical technique for treating this ventricular diverticulum, its aetiology and the possible differential diagnosis in this case.
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Affiliation(s)
- Dimitar Nikolov
- Department of Cardiac Surgery, Tokuda Hospital, Sofia, Bulgaria
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Jain S, Mahajan R, Rohit MK. Percutaneous transcatheter device closure of an isolated congenital LV diverticulum: first case report. Pediatr Cardiol 2011; 32:1219-22. [PMID: 21533778 DOI: 10.1007/s00246-011-9998-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Accepted: 04/07/2011] [Indexed: 12/01/2022]
Abstract
A congenital left ventricular diverticulum is a rare cardiac malformation. It is a developmental anomaly that occurs during embryogenesis. Presentations vary from asymptomatic patients to sudden death. To date, the treatment described has been surgical correction. The authors report the first transcatheter closure of an isolated congenital left ventricular diverticulum in a 12-year-old symptomatic girl.
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Affiliation(s)
- Siddhant Jain
- Department of Cardiology, Advanced Cardiac Centre, PGIMER, Sector 12, Chandigarh, 160012, India
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Oyama-Manabe N, Sugaya T, Yamaguchi T, Terae S. Non-coronary cardiac findings and pitfalls in coronary computed tomography angiography. J Clin Imaging Sci 2011; 1:51. [PMID: 22184544 PMCID: PMC3237007 DOI: 10.4103/2156-7514.86666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 10/03/2011] [Indexed: 11/09/2022] Open
Abstract
Non-coronary incidental findings are not rare. Kirsch et al found 67% non-coronary abnormalities with coronary computed tomography angiography (CCTA). Radiologists are expected to identify the extracoronary, intra- and para-cardiac anatomical structures and distinguish them from pathologic processes in CCTA. We have reviewed 2000 CCTA studies done at our institution with 64-MDCT. This pictorial essay presents case studies of non-atherosclerotic cardiovascular findings to recognize cardiac anatomic structures and how to distinguish them from pathologic processes. Correct interpretation of benign, clinically insignificant findings is crucial to avoid unnecessary additional imaging tests.
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Affiliation(s)
- Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, kita-ku, Sapporo, Japan
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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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Nakanishi K, Sakurai S, Kawabata T, Shimizu S. Cerebral thromboembolism in a patient awaiting surgery for left ventricular diverticulum. Interact Cardiovasc Thorac Surg 2011; 12:319-20. [DOI: 10.1510/icvts.2010.242206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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A case of left ventricular diverticulum: Change of characteristics after myocardial infarction and usefulness of cardiac computed tomography. J Cardiol Cases 2010; 2:e32-e36. [DOI: 10.1016/j.jccase.2010.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 01/18/2010] [Accepted: 01/19/2010] [Indexed: 11/19/2022] Open
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Ohlow MA, Lauer B, Geller JC. Prevalence and spectrum of abnormal electrocardiograms in patients with an isolated congenital left ventricular aneurysm or diverticulum. Europace 2009; 11:1689-95. [PMID: 19875399 DOI: 10.1093/europace/eup323] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies and can be associated with ECG abnormalities and rhythm disturbances. We sought to investigate the prevalence and the spectrum of ECG abnormalities in such patients. METHODS AND RESULTS We assessed 125 patients with isolated LVA or LVD for the prevalence of ECG abnormalities and compared the findings to an age- and gender-matched control group. The 12-lead ECG patterns were evaluated according to commonly used criteria and were classified into three subgroups (distinct, mildly, and minor). Fifty-four of the 125 patients (43.2%) had normal and 71 (56.8%) abnormal ECGs. Mean age was 66 years. Forty-nine (39.2%) were male. Distinct abnormal ECG patterns were more prevalent in patients with LVD (38.2 vs. 15.8%, P = 0.04), and apical location of the anomaly (36.6 vs. 16.6%, P = 0.02). Older age (>66 years) was associated with a trend for a higher prevalence of abnormal ECG pattern (33 vs. 18%, P = 0.06), whereas gender had no influence (32 vs. 16%, P = 0.14). This study also shows that the sensitivity, specificity, positive predictive value and negative predictive value of a 12-lead ECG for the diagnosis of LVA or LVD are low. CONCLUSION This large single-centre study suggests that the prevalence of abnormal ECG patterns in patients with isolated LVA or LVD is as high as 56.8%. However, ECG is not specific and sensitive to be used as a screening tool in such patients.
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Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, Bad Berka, Germany.
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Srichai MB, Hecht EM, Kim DC, Jacobs JE. Ventricular Diverticula on Cardiac CT: More Common Than Previously Thought. AJR Am J Roentgenol 2007; 189:204-8. [PMID: 17579172 DOI: 10.2214/ajr.06.1223] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We describe the findings of contrast-enhanced gated cardiac CT in 15 patients with 23 incidentally noted cardiac ventricular diverticula. CONCLUSION Cardiac diverticula most commonly occur in the left ventricle but have been reported to occur in all chambers of the heart. Despite reports of their rare occurrence, cardiac ventricular diverticula are fairly common findings in patients undergoing cardiac MDCT angiography.
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Affiliation(s)
- Monvadi B Srichai
- Department of Radiology, New York University School of Medicine, 530 First Ave., HCC-C48, New York, NY 10016, USA.
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Yazıcı M, Özdemir K, Altunkeser BB, Kayrak M, Ülgen S. AN ASYMPTOMATIC LEFT VENTRICULAR DIVERTICULUM. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2007. [DOI: 10.29333/ejgm/82430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Deng Y, Sun Z, Dong N, Du X. Congenital cardiac diverticulum in the subaortic valve area. J Thorac Cardiovasc Surg 2006; 132:1087-91. [PMID: 17059927 DOI: 10.1016/j.jtcvs.2006.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Revised: 07/22/2006] [Accepted: 08/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE We report and review the clinical characteristics and operative techniques of the rare malformation of congenital cardiac diverticulum in the subaortic valve area. METHODS Four male patients with congenital ventricular fibrous diverticula in the subaortic valve area are reported. RESULTS The patients' ages ranged from 4 to 47 years (mean 39 years). The first case was complicated by rupture, pseudoaneurysm formation, and a hemopericardium, and was only diagnosed on the third surgical exploration. The second case was associated with endocarditis involving both aortic and mitral regurgitation. The diverticulum was suspected on 2-dimensional transthoracic echocardiography and confirmed at surgery. In the third case, the subaortic diverticulum was associated with a rupture of the left cusp of the aortic valve with severe regurgitation. In the fourth case, the diverticulum was located between the aortic and mitral valves with a diameter of approximately 30 mm and was associated with multiple perforations of an aortic valve leaflet and severe regurgitation. There were no other congenital thoracoabdominal or cardiac anomalies. At a mean follow-up of 1 year, all patients were well. CONCLUSIONS Congenital cardiac diverticulum in the subaortic valve area is a rare anomaly. Transthoracic echocardiography and transesophageal echocardiography are reliable tools for the diagnosis and follow-up. Isolated congenital cardiac diverticula in the subaortic valve area tend to involve a benign clinical process, but may be complicated by spontaneous rupture or endocarditis. Surgical resection is performed when complications require surgical therapy.
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Affiliation(s)
- Yongzhi Deng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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: 128] [Impact Index Per Article: 7.1] [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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24
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Iyisoy A, Kursaklioglu H, Celik T, Kose S, Genc C, Isik E. A Contractile Left Ventricular Diverticulum. Int J Cardiovasc Imaging 2005; 22:1-3. [PMID: 16362173 DOI: 10.1007/s10554-005-5296-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Accepted: 04/12/2005] [Indexed: 11/27/2022]
Abstract
We present the first case report of left ventricle muscular diverticulum which stands in front of the right ventricle in an asymptomatic 20-year-old male. The diverticulum has a connection with the left ventricular outflow truct, and contracts simultaneously with the left ventricle. The patient has been included in our congenital anomaly follow-up program.
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Affiliation(s)
- Atila Iyisoy
- Department of Cardiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey
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25
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Krasemann T, Debus V, Vogt J. Calcification at the left cardiac border. Chest 2001; 119:618-21. [PMID: 11171745 DOI: 10.1378/chest.119.2.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- T Krasemann
- Department of Pediatric Cardiology, Westfaelische Wilhelms-University, Muenster, Germany.
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26
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Yildirir A, Batur MK, Kabakci G. Left ventricular septal aneurysm in association with bicuspid aortic valve--a case report. Angiology 2001; 52:73-6. [PMID: 11205936 DOI: 10.1177/000331970105200111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Diverticula of the left ventricle are rare cardiac anomalies. Most cases arise from the apex of the left ventricle and are usually found in children. Only a few cases have been documented in adults. The authors report a case of a 38-year-old woman who presented with dyspnea and chest pain. She was found to have a septal left ventricular diverticulum associated with bicuspid aortic valve, aortic stenosis, and aortic regurgitation. The aortic valve was replaced with the resection of the diverticulum. Pathologic examination confirmed the diagnosis of fibrous diverticulum.
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Affiliation(s)
- A Yildirir
- Department of Cardiology, Hacettepe University, Ankara, Turkey.
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27
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Abstract
The natural history of contractile left ventricular diverticulum in the adult is not known. Serial left ventricular angiography in an adult revealed that a left ventricular diverticulum did not increase in size over a 13-year period, suggesting that the clinical course may be benign.
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Affiliation(s)
- R A Archbold
- Department of Cardiology, London Chest Hospital, United Kingdom
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28
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Said SA, Geeraedts LM. Ventriculo-venous communications in adults: ventriculographic observations in two female patients. Int J Cardiol 1997; 62:161-5. [PMID: 9431868 DOI: 10.1016/s0167-5273(97)00186-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ventriculo-venous communications (VVC) were angiographically demonstrated in two adult female patients clinically presented with effort angina. During oxymetric studies there were minor to moderate left-to-right shunts. Concomitant, mild valvular aortic stenosis (AS) was present in one patient and hypertrophic obstructive cardiomyopathy (HOCM) in the other. It is believed that ventriculo-venous communications have contributed to the symptomatology in both patients. Symptoms were controlled medically in combination with dual (DDD) cardiac pacing with short AV-delay in one patient and only medically in the other patient. From the differential diagnostic point of view, superselective contrast injection into an 'inert' myocardial sinusoid or intramural contrast staining has been considered but could be excluded.
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Affiliation(s)
- S A Said
- Department of Cardiology, Hospital Streekziekenhuis Midden-Twente, Hengelo, The Netherlands
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29
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Fuertes Beneitez J, Merino Llorens JL, Jiménez Borreguero J, Maté Benito I, Sobrino Daza N, García de Vinuesa PG, Robles P, Galeote G, Sobrino Daza JA. [Biventricular diverticulosis associated with rheumatic heart disease: apropos of a case]. Rev Esp Cardiol 1997; 50:597-9. [PMID: 9340703 DOI: 10.1016/s0300-8932(97)73270-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We report a case of a 58-year-old woman with rheumatic mitral stenosis scheduled for percutaneous valvuloplasty. Prior left and right ventricular angiograms showed multiple diverticula at left ventricular apical and diaphragmatic walls and right ventricular diaphragmatic wall. Chest x-ray and echocardiogram were normal. Magnetic resonance imaging was concordant with catheterization findings and ruled out other cardiac malformations. The risk of ventricular perforation changed our indication of percutaneous valvuloplasty in favor of open heart commissurotomy.
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30
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Bashour TT, Espinosa E, Hoddinott R, Waxman N, Mason DT. Left ventricular narrow-neck large diverticulum caused by ischemic heart disease. Am Heart J 1997; 133:481-3. [PMID: 9124178 DOI: 10.1016/s0002-8703(97)70198-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- T T Bashour
- The Western Heart Institute, St. Mary's Medical Center at Golden Gate Park, San Francisco, CA 94117, USA
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31
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Abstract
We report the case of an asymptomatic 21-year-old European male, investigated because of an accidental cardiomegaly on chest X-ray. No electrical instability was found. A transthoracic and transesophageal two-dimensional echocardiogram showed an accessory chamber in the postero-lateral wall of the left ventricle. Perfusion and metabolism of the diverticulum were defined by position emission tomography.
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Affiliation(s)
- M C Baratella
- Department of Cardiology, University of Padua Medical School, Italy
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32
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Fernández AL, Montero JA, Alemany P, Martínez A. Diverticulum of the left ventricle associated with subvalvar aortic stenosis. Int J Cardiol 1996; 56:223-6. [PMID: 8910067 DOI: 10.1016/0167-5273(96)02743-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diverticula of the left ventricle are rare and only a few cases have been documented in adults. They may be asymptomatic or may present with embolization, pain, endocarditis, or sudden death. We report the case of a 34-year-old woman who presented a cardiac arrest with ventricular fibrillation which required electrical cardioversion. She was found to have a left ventricular diverticulum associated with a subvalvar aortic stenosis. The diverticulum arose from the apex with a narrow connection to the ventricular cavity. A subvalvar fibrous ridge stenosis with a systolic pressure gradient of 115 mmHg was observed. Coronary angiography revealed normal coronary arteries. The diverticulum and the subvalvar fibrous ridge were resected. Histologic examination of the diverticulum wall demonstrated the presence of the three normal layers with marked muscle cell hypertrophy, atypical plexiform structure and fibrous endocardium. The pathophysioloy of diverticula associated with subvalvar aortic stenosis are discussed.
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Affiliation(s)
- A L Fernández
- Cardiac Surgery Services, Hospital General de Valencia, Spain
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