Congenital Ventricular Diverticulum or Aneurysm: A Difficult Diagnosis to Make

Abstract

A pouch protruding from the free wall of the left ventricle may be either a congenital ventricular diverticulum (CVD) or aneurysm (CVA). Being aware of these rare congenital anomalies is critical in making the diagnosis. Differentiating the two is important for treatment decisions. We describe a patient with dextrocardia, Tetralogy of Fallot, and a congenital left ventricular apical diverticulum diagnosed following the induction of anesthesia. CVD and CVA may present in the antenatal period through late adulthood with differing morphology, location, and symptoms. Echocardiography is paramount in the diagnosis and characterization of these lesions. If this anomaly is encountered after the induction of anesthesia or during intraoperative echocardiography, the cardiothoracic anesthesiologist should make the surgical team aware so it can be further characterized and a treatment plan made prior to incision.

Congenital left ventricular diverticulum: A rare cause of cardiac arrhythmia

“…The decision to treat is based on the size, symptoms at presentation and prognosis 1 . Surgical resection is basically required for a larger‐sized congenital aneurysm with adverse hemodynamic effect.…”

“…A left ventricular diverticulum (LVD) is an outpouching from the ventricle with preserved synchronous contractility, and which histologically contains all three layers of the ventricular wall. In contrast, a left ventricular aneurysm (LVA) is a ventricular protuberance with akinetic or dyskinetic contraction pattern and consists histologically of mainly fibrous tissue without organized or viable myocardium 1 …”

“…In contrast, a left ventricular aneurysm (LVA) is a ventricular protuberance with akinetic or dyskinetic contraction pattern and consists histologically of mainly fibrous tissue without organized or viable myocardium. 1 Despite having different histology and presentation, both entities have the same differential diagnosis and treatment modalities as they can present with identical complications.…”

A Japanese Patient with Genitopatellar Syndrome Transiently Presenting with Cardiac Intramural Cavity during the Neonatal Period

“…CVD and CVA, recently often referred to as congenital ventricular outpouchings (CVOs) [ 8 , 9 ], are generally defined as follows: CVD is a ventricular protrusion that has normal contractility and histologically all three layers of the myocardium, and communication to the ventricular wall of CVD is narrow. In contrast, CVA is a ventricular protrusion that is akinetic or dyskinetic and histologically shows a defect or absence of the myocardium with fibrosis, and communication to the ventricular wall of CVA is broad [ 9 – 11 ]. The etiology of CVD has been considered to be failure of normal embryogenesis, while that of CVA has been considered to be mainly the result of localized ischemia in utero [ 10 , 11 ].…”

“…In contrast, CVA is a ventricular protrusion that is akinetic or dyskinetic and histologically shows a defect or absence of the myocardium with fibrosis, and communication to the ventricular wall of CVA is broad [ 9 – 11 ]. The etiology of CVD has been considered to be failure of normal embryogenesis, while that of CVA has been considered to be mainly the result of localized ischemia in utero [ 10 , 11 ]. By definition, the cardiac intramural cavity in the present case was similar to CVA in terms of abnormal contractility; by contrast, it was similar to CVD in terms of the narrow communication to the ventricle.…”