Diverticulum, or not Diverticulum, That Is the Question! Discussing About a Case of Left Ventricular Outpouching Associated With Bicuspid Aortic Valve Assessed by Cardiac Magnetic Resonance

Abstract

Congenital left ventricular outpouchings (LVOs) are infrequent myocardial malformations, comprising various overlapping abnormalities, whose characterization is often intricate in clinical practice using traditional non-invasive techniques. We describe a rare case of LVO associated with bicuspid aortic valve incidentally found in an asymptomatic adult patient. The LVO was located at basal level of the chamber, crescent-shaped with its largest diameter in short-axis view and presented a thin hypo-contractile wall without hyperintense areas on late gadolinium enhanced (LGE) images. This description corresponds to an overlap between usual definition of aneurism, fibrous and muscular diverticulum. The LVO was evaluated according with a classification recently proposed by Malakan Rad. In this case ventricular geometry was not respected, wall thickness was reduced and wall motion compromised therefore corresponding to a small IIc-type, which is considered having the poorest prognosis. Furthermore, the association with bicuspid aortic valve is very unusual. The patient refused surgery and preferred follow-up.

Left ventricular diverticulum in association with bicuspid aortic valve and pseudocoarctation: Hitherto unreported association

“…2,4 These congenital diverticula are mostly associated with a number of other thoracoabdominal wall defects, including those of sternum, pericardium, and diaphragm, in particular Cantrell's syndrome. 1–5…”

“…2,4 These congenital diverticula are mostly associated with a number of other thoracoabdominal wall defects, including those of sternum, pericardium, and diaphragm, in particular Cantrell's syndrome. [1][2][3][4][5] Although these are mostly asymptomatic in adults, they may present with chest pain rarely, in case they have associated coronary artery disease. 6 If not associated with the latter, as was seen in our case, they may present with nonspecific abnormalities on resting electrocardiogram, including atrial ectopic beats, ST-T wave changes, and arrhythmias.…”

A case report: multiple right ventricular diverticula with constrictive pericarditis and right heart failure

“…Recent limited autopsy series have implied left ventricular diverticulum to have an incidence of 0.4%, 6 whereas a CT series have documented a frequency of 2.2% 7 . Ventricular diverticulum can be differentiated from ventricular aneurysm due to presence of a muscle layer, usually a narrow neck and synchronous contractility with the rest of the ventricle 8 . A ventricular aneurysm being composed of only two layers, has a wide neck and may exhibit variable contractility ranging from akinesia to dyskinesia i.e.…”

Congenital left ventricular aneurysm diagnosed with atrial septal defect

“…In contrast, LV diverticulum is composed of 3 layers (endocardium, myocardium, epicardium). 5 Cardiac mortality caused by congestive heart failure and rupture is considered to be more frequent in LV aneurysms. Therefore, it is important to distinguish LV aneurysm from LV diverticulum because it affects the timing and indication for surgical intervention.…”