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

Abstract

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.

Keywords: CT angiography; Congenital cardiac malformation; Echocardiography; Left ventricular diverticulum.

Fig. 1

A tubular structure protruding from the abdominal wall, soft and contracting with the heartbeat (white arrow)

Fig. 2

Ultrasound 2 days after birth: (A, B) Perimembranous ventricular septal defect with diameter 2.2 mm (blue arrow), PFO 2.6 mm (orange arrow); (C, D, E) Left ventricular diverticulum (blue star), with transverse section size 4.1 × 3.9 mm and there was flow spectrum on Doppler ultrasound. RV: right ventricle; LV: left ventricle; RA: right atrial; LA: left atrial; PFO: patent foramen ovale. (Color version of figure is available online.)

Fig. 3

MSCT images at 5 days old: (A, B) 3D reconstruction images showed left ventricular diverticulum (blue arrow); right SCA arose directly from the aortic arch distal to the left SCA (orange arrow); the common trunk of bilateral CCA (blue star); (C) right SCA coursed posterior to the trachea (Arteria lusoria); (D) perimembranous VSD with diameter 5.7 mm. SVC: superior vena cava; SCA: subclavian artery; CCA: common carotid artery; VSD: ventricular septal defect. (Color version of figure is available online.)

Fig. 4

MSCT images at 3 months old: (A) Sagittal MIP reconstruction images showed left ventricular diverticulum, protruding from the abdominal wall, coursed along the midline; Axial MIP reconstruction images(B) and 3D reconstruction images (C, D, E) showed that the LVD originated from the heart apex; the common trunk of bilateral CCA as the first branch and the left SCA as the second branch of Aorta arch.

Fig. 5

Cardiac MSCT images: (A, B) Axial images showed perimembranous VSD with diameter 4.4 mm; right SCA (blue arrow) coursed posterior to the trachea without causing stenosis of trachea lumen; (C) Coronal MIP image showed the common trunk of bilateral CCA and the aberrant right SCA. (Color version of figure is available online.)

Fig. 6

The pathology image showed a tubular structure with three layers of the heart wall.