Double-Chambered Left Ventricle
Complete Characterization by Cardiac Magnetic Resonance and Multidetector-Row Computed Tomography
A 22-year-old physically active man with no significant medical history was referred for evaluation of a cardiac murmur. A transthoracic echocardiogram showed a possible lateral wall aneurysm in the left ventricle (LV). Cardiac magnetic resonance (CMR) was performed with a 1.5-T clinical magnet. The examination consisted of the quantification of biventricular function with cine imaging; T1, T2, and proton density–weighted dark blood sequences; evaluation of first-pass myocardial perfusion; and the acquisition of delayed images for the presence of hyperenhancement. A large aneurysm-like structure (ALS) measuring 73 mm in the long axis and 26 mm in the short axis was noted in the anterolateral LV wall. Results of the spin echo (dark blood) sequences revealed tissue characteristics and morphology that are consistent with normal myocardium (Figure 1). The majority of the ALS was contractile (Movie I). In the short-axis view, a thin membrane separating both chambers and a systolic flow jet leaving the ALS and entering the primary LV chamber were noted (Movie II). The results of the myocardial perfusion study of the primary LV and ALS chambers were normal (Movie III). Delayed hyperenhancement images showed no evidence of myocardial scarring (Figure 2). A 16-slice multidetector-row computed tomography (MDCT) examination was performed with no evidence of congenital coronary anomaly or stenosis. Large diagonal and marginal branches supplying the ALS territory were noted (Figures 3 and 4⇓).
Dr Sanz’s work is supported in part by a research grant from the Spanish Society of Cardiology.
The online-only Data Supplement, which contains Movies I through III, is available with this article at http://www.circulationaha.org.