Prenatal diagnosis of fetal right ventricular diverticulum with massive pericardial effusion in one of monochorionic diamniotic twins: a case report with a favorable outcome following in utero pericardiocentesis

Abstract

Background Congenital ventricular diverticulum is a rare abnormality that may occur as an isolated malformation. Most cases are accompanied by pericardial effusion. Prenatal counseling can be difficult because the prognosis is uncertain and there is no consensus approach to prenatal management. Case presentation: We describe a case of congenital cardiac diverticulum complicated by large pericardial effusion in one of monochorionic diamniotic twins. The case was diagnosed by ultrasonography at 21 weeks of gestation. Therapeutic pericardiocentesis at 22 weeks resulted in complete resolution of the effusion and led to a favorable fetal outcome. We summarize the interventions and pregnancy outcomes in cases of cardiac diverticula reported in the literature. Conclusions Better awareness of clinical features, in utero therapies, and pregnancy outcomes could help define and improve prenatal management of congenital ventricular diverticula.

Novel TrueVue series of 3D echocardiography: Revealing the pathological morphology of congenital heart disease

“…TrueVue Glass has an obvious advantage in the diagnosis of pulmonary artery sling, and it is the first time that an innovative 3D ultrasound technology has been used to diagnose such rare cardiovascular malformations. Rare ventricular diverticulum, with its narrow entrance and long shape, may be easily missed or misdiagnosed as a paracardiac vessel on 2D ultrasound ( Sozzi et al, 2017 ; Wang et al, 2021 ). The TrueVue Light highlights the interior space features of the diverticulum.…”

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

“…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 ]. According to a recent study, among the 40 reported cases, only two cases of CVD occurred in multiple pregnancies, which were monochorionic diamniotic twins [ 2 , 11 ].…”

“…Congenital ventricular diverticulum (CVD) is a cardiac malformation defined as an outpouching lesion of a ventricle with normal contractility and thickness, and the advancement of prenatal sonography has led to its prenatal diagnosis [ 1 , 2 ]. In the prenatal period, CVD is reported in association with pericardial effusion, arrhythmia, and fetal hydrops or as an isolated condition [ 2 , 3 , 4 , 5 ]. When a ventricle shows outpouching, it is necessary to differentiate CVD from congenital ventricular aneurysm (CVA).…”

“…When a ventricle shows outpouching, it is necessary to differentiate CVD from congenital ventricular aneurysm (CVA). Histologically, a CVD lesion contains the myocardium in its wall, while a CVA lesion lacks the myocardium within its wall but contains fibrous tissue [ 2 ]. 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 ].…”

“…Histologically, a CVD lesion contains the myocardium in its wall, while a CVA lesion lacks the myocardium within its wall but contains fibrous tissue [ 2 ]. 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 ].…”