Surgical treatment of congenital left ventricular diverticulum

[Tratamiento endovascular exitoso de aneurisma del ventrículo izquierdo en un paciente pediátrico]

BACKGROUND

Aneurysms and diverticula of the left ventricle are rare entities in childhood, with a prevalence of less than 0.1%. Described since 1886, as a severe and potentially fatal disease if not corrected, mainly due to the presence of associated anomalies and the risk of rupture.

OBJETIVE

Present other management options for ventricular diverticula, different from surgical options, using alternative materials that are not used very often in daily practice.

METHOD

A detailed description of a case successfully managed with these new treatment modalities.

RESULTS

Endovascular management of the left ventricular diverticulum, diagnosed prenatally in the patient presented, was successful after initial failure with surgical management.

CONCLUSIONS

Endovascular management of ventricular diverticula, using alternative materials to those commonly used, is an attractive option with satisfactory results in these patients.

Congenital Ventricular Diverticulum

Herein, we describe a 54-year-old patient with a congenital ventricular diverticulum (CVD), referred to our emergency department for presyncope episodes and multiple re-entrant ventricular tachycardias (VT). Significantly, echocardiographic findings were not clear, and the diagnosis was made by cardiac magnetic resonance imaging (CMRI), which showed the presence of an apical accessory cavity connected to the ventricle and contracting synchronously. CMRI allowed the differential diagnosis with other outpouching cardiac defects. The patient underwent a subcutaneous implantable cardioverter defibrillator (S-ICD) implant and was referred for heart transplantation (HT). The diagnosis, treatment, and main findings of the CVD are discussed in this case report.

Successful surgical resection of a complicated left ventricular diverticulum in a neonate presented with unexplained anemia: a case report

Congenital left ventricular diverticulum (LVD) is a rare congenital cardiac anomaly and may be complicated by fatal adverse events such as diverticulum rupture. Most LVD cases are asymptomatic and often discovered incidentally. Herein, we describe an unusual and peculiar clinical presentation with felicitous surgical management of ruptured LVD.

Case presentations

A 10-day-old male infant presented with severe, intractable, and unexplained anemia associated with respiratory distress. Upon admission, the patient was clinically shocked with a hemoglobin level of 6.0 g/dl. As chest imaging showed cardiomegaly, echocardiography was performed and revealed a 9×10 mm diverticulum arising from the posterolateral wall of the left ventricle along with blood and clot collection in the pericardium. The patient underwent an urgent surgical resection of the diverticulum. He was followed up for 2 years without any readmissions or cardiac complaints.

Clinical discussion

Systemic thromboembolism, heart failure, infarction, and tachyarrhythmias have all been reported as complications of LVD. The most serious complication is diverticulum rupture, which can result in death. As a result, this congenital defect should be discovered early to determine the potential risks and plan appropriate treatment.

Conclusion

Congenital heart defects such as LVD should be suspected in neonates presenting with unexplained and intractable anemia. To avoid the diagnosis confusion and risk of serious complications in LVD patients, such as spontaneous rupture of the diverticulum, we advocate immediate surgical management of LVD in children.

Isolated muscular ventricular diverticulum assessment using multi-parameter echocardiographic imaging: Case reports

Ventricular diverticulum (VDi) is a rare and often asymptomatic congenital cardiac malformation detected incidentally as an outpouching on routine imaging examination, of which the muscular type has been less reported. Here, two patients were incidentally found to have outpouchings of the ventricle during routine transthoracic echocardiography. After a series of multi-parameter echocardiography examination, including two-dimensional (2D), three-dimensional (3D) photo-realistic rendering, blood speckle tracking (BST), and contrast enhancement, to provide morphological structure, spatial relationship, and blood flow information, both cases were finally diagnosed with muscular VDi. These cases highlight the advantages of using multi-parameter echocardiography for the comprehensive assessment of muscular VDi.

Left ventricular diverticulum: A case report and review of the literature

Left ventricular diverticulum is a rare congenital left ventricular outpouchings. The disease is often diagnosed during childhood because it is frequently associated with midline thoracoabdominal defects and other congenital cardiac anomalies. Most cases are asymptomatic, often discovered incidentally. Some complications have been reported including infarction, arrhythmia, heart failure. The most severe complication is rupture of the diverticulum, which can cause a patient's death. Therefore, this congenital defect should be detected early to assess potential risks for appropriate treatment. In this article, we report a case of a 3-month-old boy with left ventricular diverticulum diagnosed with Doppler ultrasound and cardiac MSCT. Complete resection was undertaken. The patient remained asymptomatic with good heart function 2 months after surgery.

Congenital Left Ventricular Diverticulum Complicated by Cardioembolic Stroke

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Congenital LVD is a rare cause of stroke in young patients.

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LVD results from replacing myocardium with fibrous or muscular tissue.

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Diverticulum and pseudoaneurysm are in the differential diagnosis of LV outpouching.

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LVD forms a cavity that communicates with the LV through a short neck.

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LVDs that result in thrombus formation and stroke should be resected.

[Ventricular diverticulum in Cantrell´s pentalogy: rare but not isolated entities]

Pentalogy of Cantrell is a rare entity characterized by a combination of alterations, among which the following stand out: defects of the pericardium, heart, diaphragm, lower third of sternum and abdominal wall. On the other hand, congenital cardiac diverticulum is a rare malformation whose presentation is associated with Cantrell's pentalogy in some cases. We present the case of a child with Cantrell's pentalogy who, during follow-up, was diagnosed with left ventricular diverticulum, which required surgical management with a favorable outcome. Addressing these conditions requires the use of cardiovascular images that allow timely decision-making by the treating team.

Congenital Subaortic Left Ventricular Muscular Diverticulum

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LVD can rarely present in the subaortic position.

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A muscular LVD has synchronous contraction; an aneurysm does not.

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Subaortic LVD may be associated with aortic regurgitation, thrombus, and arrhythmia.

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An isolated LVD may be followed conservatively with noninvasive imaging.