Multiple Left Ventricular Diverticula Detected by Second Harmonic Imaging-A Case Report-

Takahashi, Masaki; Nishikimi, Toshio; Tamano, Kouichi; S, Hara; Kobayashi, Tsutomu; Honda, Takeshi; Uetake, Shuichiro; Mitobe, Rieko; Matsuoka, Hiroaki

doi:10.1253/circj.67.972

Cited by 27 publications

(22 citation statements)

References 9 publications

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“…Another large retrospective echocardiographic study showed a prevalence of a left ventricular diverticulum of 0.04% (13). In our study, the prevalence of left ventricular apical diverticulum was 1.14%, higher than that reported previously.…”

Section: Discussioncontrasting

confidence: 71%

Association between myocardial hypertrophy and apical diverticulum: more than a coincidence?

Sivrioğlu¹,

Sağlam²,

Öztürk³

et al. 2013

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSE We aimed to investigate the possible association between the myocardial hypertrophy and the development of an apical diverticulum. MATERIALS AND METHODSWe retrospectively reviewed 786 multidetector computed tomography (MDCT) coronary angiography examinations (520 males, 266 females; mean age, 57±15 years; age range, 18-78 years). The end-diastolic left ventricle wall thickness was measured in all patients, and a wall thickness of 11 mm was determined to be the cut-off value for myocardial hypertrophy. The ventricular apex and subvalvular area were evaluated for ventricular diverticula. The difference between the apical diverticula in patients with and without myocardial hypertrophy was determined. RESULTSThere were 12 myocardial hypertrophy and nine apical diverticulum cases. Myocardial hypertrophy was observed in four (44%) of nine patients who had apical diverticula, and an apical diverticulum was observed in four (33%) of 12 patients who had myocardial hypertrophy. There was statistically significant difference for myocardial wall thickness between the apical diverticula in patients with myocardial hypertrophy and those without myocardial hypertrophy (P = 0.011). CONCLUSION Diagnosis of apical diverticula has become easier by using imaging modalities such as MDCT. There may be an association between myocardial hypertrophy and apical diverticulum.A pical diverticula are rare cardiac abnormalities consisting of a localized outpouching from the apex of the left ventricle. They are primarily congenital, occurring in isolation or in association with other abnormalities. Noncongenital cases are also seen in an isolated form in adults. A few cases have been described in which there is apparently an association between myocardial hypertrophy and apical diverticula (1-4).Recently, multidetector computed tomography (MDCT) has become a major diagnostic tool in cardiac imaging, showing both the coronary arteries and other cardiac and extracardiac structures, such as the myocardium, cardiac chambers, major vessels, and mediastinum (5). In this study, we investigated the association between myocardial hypertrophy and the development of apical diverticula. Materials and methods Patient selectionWe retrospectively reviewed 786 MDCT coronary angiography examinations performed in our department between October 2009 and May 2012, for the presence of apical diverticula.The institutional ethics committee approved this retrospective study (No: 2012-77 GATA Haydarpaa Teaching Hospital, ‹stanbul, Turkey). Written informed consent was obtained from all patients. Overall, there were 520 men and 266 women, with ages ranging from 18 to 78 years (mean, 57±15 years). The indications for MDCT coronary angiography were suspected coronary artery disease (n=681), coronary artery anomaly (n=36), coronary artery stent patency (n=27), and coronary artery bypass graft assessment (n=42). ImagingThe MDCT coronary angiography examinations were performed using a 64-MDCT scanner (Brilliance-64, Phillips Medical Systems, Eindh...

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Section: Discussioncontrasting

confidence: 71%

Association between myocardial hypertrophy and apical diverticulum: more than a coincidence?

Sivrioğlu¹,

Sağlam²,

Öztürk³

et al. 2013

Diagn Interv Radiol

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“…Accompanying malformations can be assessed in the same setting and quantified by (color) Doppler flow measurements. Contrast harmonic power Doppler imaging provides information about contractility and myocardial perfusion of congenital left ventricular aneurysms or diverticula [26, 49, 89]. However, especially in adults, small apical changes can be missed due to difficult visualization of the left ventricular apex (fig.…”

Section: Diagnostic Studiesmentioning

confidence: 99%

Congenital Left Ventricular Aneurysms and Diverticula: Definition, Pathophysiology, Clinical Relevance and Treatment

2006

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A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation; 411 cases have been reported since its first description in 1816, and other cardiac, vascular or thoraco-abdominal abnormalities have been shown in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic or may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventricular angiography, visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications; treatment options include surgical resection especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator in case of symptomatic ventricular tachycardia, occasionally combined with class I or III antiarrhythmic drugs.

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“…As seen in our case, the wall of diverticulum is formed by endocardium, myocardium and pericardium, and contracts normally, whereas an aneurysm is a fibrous saccular lesion and contracts paradoxically (1,8). As in our case, many cardiac diverticulae are clinically silent, but they can cause ventricular disrhythmia, systemic embolisms, or ventricular rupture and sudden death (10,11). The prognosis of isolated, asymptomatic left ventricular diverticulum is unknown.…”

Section: Discussionmentioning

confidence: 45%

An Asymptomatic Left Ventricular Diverticulum

et al. 2007

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Congenital ventricular diverticulum is defined as a protrusion of the free wall of the ventricle, including endocardium, myocardium and pericardium. They have been classified in fibrous and muscular types. Congenital ventricular diverticulum may be asymptomatic or may be present with various clinical symptoms. Diverticulum is commonly seen in childhood, and fibrous type being the most common type. Muscular type is very rare seen in adults. We report here, a case with muscular type asymptomatic congenital left ventricular diverticulum in a 65 year-old female.

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Multiple Left Ventricular Diverticula Detected by Second Harmonic Imaging-A Case Report-

Cited by 27 publications

References 9 publications

Association between myocardial hypertrophy and apical diverticulum: more than a coincidence?

Association between myocardial hypertrophy and apical diverticulum: more than a coincidence?

Congenital Left Ventricular Aneurysms and Diverticula: Definition, Pathophysiology, Clinical Relevance and Treatment

An Asymptomatic Left Ventricular Diverticulum

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