Double chambered left ventricle is a rare anomaly and unlike double chambered right ventricle, is not well documented. We report a case occurring with tetralogy of Fallot, an association not thus far described.Key words: Double chambered left ventricle; double chambered right ventricle; aneurysms; diverticulums U NLIKE DOUBLE CHAMBERED RIGHT VENTRICLE, DIVIsion of the left ventricle is a rare anomaly; often with the accessory chamber being an aneurysm or diverticulum. ' 4 We are aware of only one case 4 where a muscular partition divided the left ventricle into two components in a fashion comparable to double chambered right ventricle. 5 We report here a second case of muscular division of the left ventricle in a patient with tetralogy of Fallotan association that, to the best of our knowledge, has not previously been recorded.
Case reportA three-year-old female child was admitted with a history of cyanotic spells and squatting episodes since childhood. Examination revealed a precordial bulge with a systolic murmur at the apex. Cross-sectional echocardiography revealed features of tetralogy of Fallot. The child, however, suffered severe respiratory infection, and died before surgical correction could be attempted. At autopsy, the heart weighed 160 grams with marked enlargement of the right atrium, right ventricle and moderate enlargement of left ventricle.There was the typical morphology of tetralogy of Fallot, with additional marked stenosis of the pulmonary valve, which had only 1 mm sized probe patent central orifice.A muscular ridge was seen extending upwards from the apex of the left ventricle for a length of 1.5 cm (Figure 1). This muscular band connected the septal surface of the left ventricle with the posterior left ventricular wall, thus dividing the left ventricle into two components, a large anterior and a small posterior one, each with its separate and distinct apex. The larger anterior chamber received the mitral valve and also gave rise to the aorta. The orifice between the two chambers was nonrestrictive, and its posterior margin was bounded by a prominent muscle band which was partly confluent with the belly of the posteromedial papillary muscle (Figure 2). The superior margin of the orifice was bounded by a muscular ridge separating it from the subaortic ventricular septal defect. The inferior margin was formed by the crest of the muscular ridge.
DiscussionDouble chambered left ventricle is extremely rare. Of those cases reported, some are due to aneurysms and diverticulum arising in different parts of the left ventricle. 1>2 These pockets are believed to be of post-inflammatory etiology or due to defects or hypoplasia of the myocardial wall. Kay et al 3 reported a single case successfully treated by exclusion of the accessory chamber. The wall of this chamber had viable myocardium and communicated with the main body of the left ventricle through a large fibrous orifice. There is no description of any anomalous muscle bundle dividing the left ventricle. Gerlis and his colleagues 4 described thre...
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