Prenatal diagnosis of left ventricular aneurysm: a report of three cases and a review

Abstract

We report three cases of left ventricular aneurysm diagnosed prenatally and followed by fetal Doppler echocardiography. A review of the literature reveals a paucity of information about this rare cardiac malformation. Most of the described cases (6 out of 9) have remained asymptomatic during pregnancy and after birth. Our cases, in contrast, and three others in the literature, had an ominous prognosis presenting cardiac failure initially or during follow up and showing a dynamic evolution of the aneurysm. Cross-sectional echocardiography provides the diagnosis, revealing the thin-walled aneurysm, usually apical, to be connected by a broad neck to the left ventricle. Color and pulsed Doppler shows low velocity and to-and-fro flow in the aneurysm. Sequential fetal Doppler echocardiography detects the potential growth of the aneurysm relative to ventricular size, revealing any compromise of cardiac performance by a decreased mitral opening, reversed atrial shunting, a hypokinetic infero-posterior left ventricular wall, and a poor systolic thickening of the wall of the aneurysm. Compromise of cardiac function, and deleterious impact on development of the lungs during fetal life, may depend on the early onset, growth and location of the aneurysm,which may occupy most of the fetal chest. We discuss issues of prenatal diagnosis, sequential surveillance of the natural history, and factors of prognosis as well as myocardial histological data from one of our cases.

Congenital Cardiac Left Ventricular Aneurysm With Pericardial Effusion

“…In the absence of in utero cardiovascular impairment, there appears to be a good prognosis. However, as previously reported by CavalleGarrido et al, 1 Matias et al, 5 and McElhinney and Silverman, 6 aneurysmal enlargement may be indicative of poor prognosis, as are the findings of ascites and hydrops. In addition, it appears that the earlier the defect is detected, the more serious the prognosis.…”

“…All cases of intrauterine cardiac failure were associated with fetal death. 5 In summary, we present a case of the earliest reported detection of congenital left ventricular aneurysm with pericardial effusion. Removal of …”

“…In addition, it appears that the earlier the defect is detected, the more serious the prognosis. 6,9 Matias et al 5 proposed that larger lesions were associated with poorer prognosis secondary to volume overload on the heart. The progressive nature of the size may also indicate a worsening prognosis, as in our case.…”

Prenatal and Postnatal Management of a Patient with Pentalogy of Cantrell and Left Ventricular Aneurysm

“…Rather than a non-contractile bulging of the left ventricle into the epigastrum with an elongated shape and a narrow connection with the main cavity described in pentalogy-associated diverticula [11] , we see a large protrusion of the portion of the left ventricle with a broadbased connection to the main cavity. While diverticulae associated with pentalogy are relatively common, congenital aneurysms are rarer and may be contractile [12] . Aneurysms can be located subaortic, submitral, or apical, and have a prevalence of 0.5 in 100,000 births [13] .…”

Prenatal Echocardiographic Appearance of Arrhythmogenic Right Ventricle Dysplasia: A Case Report

“…The clinical consequences of the lesion depend on the size of the aneurysm and on gestational age at diagnosis, with possible progression to fetal heart failure. Few cases have been reported in prenatal life, and those few have always involved the left ventricle in the apical or subvalvular region [7,8].…”