Left Ventricular Diverticulum in an Adult Patient
A49-year-old woman underwent cardiac evaluation because of an abnormal ECG. She had undergone multiple surgical procedures during her infancy for congenital right tibial aplasia and polydactyly. At the age of 33 years, she had undergone cardiac evaluation after a questionable episode of supraventricular tachycardia and an abnormal ECG (Figure 1⇓). An echocardiogram revealed left ventricular hypertrophy; coronary angiography and left ventriculography were normal.
A routine follow-up in 1998 with a 2D echocardiogram demonstrated a large apical diverticulum (D) (Figure 2⇓; LV indicates left ventricle; LA, left atrium). Cardiac catheterization with left ventriculography (Figure 3⇓) and MRI (Figure 4⇓) showed a diverticulum originating at the apex of the left ventricle. The patient underwent cardiac surgery with excision of the diverticulum and pericardial patch repair without complications.
Congenital diverticulum of the ventricle is a rare cardiac malformation initially described in 1838.1 It is usually detected in children and was described in detail by Cantrell et al in 1958 as part of a pentalogy.2 The classic clinical picture is characterized by congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart. At least 9 patients, all newborn, with associated limb malformations have been described.3 In 30% of the cases, left ventricular diverticulum is not associated with congenital malformations and is referred to as isolated left ventricular diverticulum.
Prognosis depends on the severity of the cardiac and associated malformations. In patients with complex cardiac malformations who undergo surgery during the first days of life, mortality can be as high as 50%. Cardiac rupture, tamponade, sudden death, endocarditis, peripheral embolism, heart failure, and arrhythmia have all been described as complications and causes of death.3 4
Surgical resection with repair of the associated malformations, even in asymptomatic patients, is the treatment of choice to prevent potentially catastrophic complications.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
- Copyright © 2000 by American Heart Association