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. 2015 Oct;27(4):277-82.
doi: 10.1016/j.jsha.2015.05.001. Epub 2015 May 19.

Congenital ventricular diverticulum and MI - Diagnostic challenges and implications

Fayez Elshaer  1 , Fahad Altwijri  2 , Faris Alrasheed  3 , Suleiman Kharabsheh  4 , Walid Habeeb  1
Affiliations

Congenital ventricular diverticulum and MI - Diagnostic challenges and implications

Fayez Elshaer et al. J Saudi Heart Assoc. 2015 Oct.

Abstract

The use of modern cardiac imaging techniques suggests that congenital ventricular diverticulum (CVD) may be more common than generally believed and may present asymptomatically in adult life. We present a case of congenital left ventricular diverticulum diagnosed in a patient presenting with myocardial infarction (MI). The case highlights the importance of the differential diagnosis of CVD from post infarct left ventricular aneurysms (PILVA) and suggests that adult studies using modern imaging techniques are needed to define the prognosis for asymptomatic CVD in order to guide management.

Keywords: Aneurysm; Myocardial infarction; Outpouch; Ventricular.

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Figures

Figure 1
Figure 1
Coronary angiography and PCI to RCA. Left circumflex coronary artery (LCx), obtuse marginal coronary artery (OM), left anterior descending coronary artery (LAD), right coronary artery (RCA).
Figure 2
Figure 2
Preoperative Echocardiography and Magnetic Resonance Angiography. Pre-operative transthoracic echocardiography demonstrated: (a) A narrow necked pulsatile cavity postero-lateral to the left ventricular outflow tract. The aortic valve (AV), ventricular outpouch (VO), and left atrium (LA) are indicated. (b) A bicuspid aortic valve with severe aortic stenosis (gradient of 79/50 mm/Hg) and mild aortic regurgitation. Pre-operative transesophageal echocardiography demonstrated. (c) The ventricular outpouch (VO) lying posterior to the aorta (AO) and excluded aortic dissection. (d) Doppler ultrasound confirmed flow in the outpouch. Pre-operative magnetic resonance angiography. (e) Further delineated anatomy with the ventricular outpouch (VO) being visualized lying between the aorta (AO) and left atrium (LA).
Figure 3
Figure 3
Operative procedure. (a) Native aortic valve (AV) before replacement. (b) Ventricular outpouch. (c) Prosthetic aortic valve (PV) in situ.
Figure 4
Figure 4
Postoperative Echocardiography. Echocardiographic images acquired post-surgery. (a) The position of the ventricular outpouch (VO) is demonstrated between the left atrium (LA) and left ventricle (LV). (b) Doppler imaging demonstrates complete absence of flow in the ventricular outpouch (VO). The right atrium (RA), left atrium (LA), right ventricle (RV), and left ventricle (LV) are indicated.
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