Fetal Right Ventricular Diverticulum Detected by Prenatal Ultrasound Screening

Abstract

Prenatal ultrasound screening has allowed for the detection of in utero cardiac abnormalities. Specifically, distinction is possible between ventricular diverticula and aneurysms, which is important because each condition has a different clinical outcome. We report the case of a 35-year-old, gravida 1, para 1 woman, with no significant past medical history, who underwent routine prenatal ultrasound screening at 32 weeks' gestation. A four-chamber ultrasound of the fetal heart combined with M-mode echocardiography showed abnormal dilatation of the right ventricular chamber measuring 2.2 cm × 1.0 cm but with normal contractility. Delivery was performed at full term by cesarean section, and a right ventricular diverticulum was confirmed by postnatal cardiac computed tomography. The baby developed normally with no cardiac sequelae during followup. This case demonstrates the importance of making a correct diagnosis of ventricular diverticula by prenatal ultrasound when abnormal dilatation of the fetal ventricle is identified during routine screening. Because evaluating the wall contractility by M-mode ultrasound leads to evaluating whether it has the myocardium, we conclude that M-mode echocardiography is effective for the purpose of prenatal cardiac diagnosis and can distinguish between ventricular aneurysms and functioning ventricular diverticula.

Prenatal Diagnosis of Right-Sided Congenital Ventricular Diverticulum (CVD) Assisted by Spatiotemporal Image Correlation (STIC) Acquisition and the Speckle-Tracking Technique to Assess Fetal Cardiac Function: A Case Report

“…The evaluation of the integrity of the wall, which has a similar thickness and layering as the rest of the ventricle in patients with CVD, is made by B-mode ultrasonography [ 12 ]. Last, synchronous movement of the wall, which is observed in patients with CVD, is confirmed through M-mode ultrasonography [ 6 ].…”

“…Ventricular diverticulum is a rare cardiac malformation, and one report estimated its approximate incidence to be 0.013% [ 6 ]. Although one case of RV diverticulum was reported at a GA of 12 weeks, most cases (75%) were diagnosed after the first trimester [ 2 ].…”

“…The echocardiographic features used in the prenatal diagnosis of CVD include a narrow size of the communication with the ventricle, intact ventricular thickness, and normal contractility. Regarding communication size with the ventricle in CVD, there were cases in which the size was reported to be large, or the size measurement was inadequate because of location, so there is a limit of communication size as a differentiation point [ 6 , 12 ]. The evaluation of the integrity of the wall, which has a similar thickness and layering as the rest of the ventricle in patients with CVD, is made by B-mode ultrasonography [ 12 ].…”

“…Ultrasonography is the only prenatal method to distinguish between the two conditions, and sonographic findings of CVD typically include an outpouching ventricle with a saccular shape, a narrow base and normal contractility [ 2 ]. Sonographic techniques such as B-mode and M-mode ultrasonography have been used to identify CVD [ 6 ]. Spatiotemporal image correlation (STIC) acquisition, a novel approach for the clinical evaluation of fetal hearts, has never been used for CVD diagnosis and evaluation.…”

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

“…Congenital ventricular diverticulum is a rare cardiac anomaly with a reported incidence of 0.013–0.016% 1 , 2 . It can be found anywhere in the right or left ventricular wall; commonly in the apex and perivalvular region.…”