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

Abstract

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.

Aneurismas y divertículos cardíacos congénitos: reporte de una serie pediátrica

“…El ventrículo izquierdo es la localización más frecuente, específica-mente el ápex y el área perivalvular mitral 6 . En nuestra serie, 2 pacientes presentaron compromiso del ápex del VI, 2 pacientes del septum y 1 del VD.…”

“…Se asocian frecuentemente con malformaciones cardíacas y extracardíacas más frecuentemente defectos interventriculares. En una revisión de 411 casos de la literatura 108 (26%), se asociaron con comunicación interventricular (CIV) 6 . En nuestro grupo dos pacientes presentaron dicha asociación.…”

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

“…Fibrous ventricular diverticula often show akinetic or dyskinetic contractile function during ventricular systole. Histologically, while muscular diverticula contain all layers of the ventricular myocardium, with preserved myocardial architecture and minimal fibrous tissue, fibrous diverticula typically have connective tissue, composed of reticulin fibers; few or no muscle fibers are present (18). Fibrous diverticula with a narrow neck are commonly located in the subvalvular area and are often associated with valvular incompetence (19).…”

Left ventricular diverticulum: incidental finding on dual source cardiac ct

“…viral infections or vascular accidents (11). Congenital ventricular diverticuli should be differentiated from other causes of acquired ventricular aneurysms such as those after myocardial infarction, myocardial inflammatory disease such as sarcoidosis or myocarditis, infectious endocarditis or trauma (12). Differential diagnosis with acquired ventricular aneurysms can not be made with certainty based on imaging alone.…”