Double‐chambered left ventricle diagnosis by 2D and 3D echocardiography: From fetus to birth

Abstract

A 26-year-old pregnant woman, 24 weeks gestation, underwent fetal echocardiography because of abnormal fetal heart on routine obstetric ultrasound screening. The maternal and pregnancy medical histories were normal. 2D and 3D Fetal echocardiography showed the left ventricle (LV) divided into two chambers by an abnormal transverse muscular tissue at the level of the papillary muscle. The overall LV systolic function was normal. The communication between the two chambers was 2.1 mm in diameter and showed clear evidence for bidirection flow on color Doppler with a diastolic velocity of 61 cm/s and systolic velocity of 58 cm/s ( Figure 1A,B). After delivery, a transthoracic echocardiogram showed the same findings reported during fetal life. The baby was asymptomatic and the ECG was normal. One and a half year after birth, LV systolic function remained normal (EF 65%) as was diastolic function (E wave velocity 120 cm/s, A wave velocity 60 cm/s and E/A = 2). LV wall motion also was normal and the communication between the LV main chamber and accessary chamber became 5 mm. The bidirection flow acrossing the connection between the two chambers was slightly faster with diastolic velocity 157 cm/s and systolic velocity 102 cm/s ( Figure 1C,D). | D ISCUSS I ONDouble-chambered left ventricle is a very rare congenital cardiac anomaly, the two chambers of DCLV are in parallel with superior/ inferior chambers or left/right chambers. 1 This anomaly can exist in isolation or in association with other congenital anomalies. The pathogenesis of DCLV is unknown. 2,3 Some cases have been reported as related to cardiomyopathy and some ischemic, viral or genetic factors, but the underlying evidence for those etiologies is weak. 4-6 Because of the rarity of DCLV, few data exist on about its treatment and clinical outcomes. 7-10 Surgical intervention is indicated only if DCLV is complicated with other congenital anomalies. 11 DCLV should be distinguished from ventricular aneurysm and ventricular diverticulum, the former is usually secondary to myocardial infarction and does not contain all layers of myocardium and may show dyskinetic segments. The latter is congenital Double-chambered left ventricle (DCLV) is a rare cardiac anomaly and is characterized by the division of the left ventricle by abnormal muscle and/or fiber bundles into two chambers. We hereby report a fetus which was diagnosed with DCLV in utero by 2D and 3D Fetal echocardiography and the findings were confirmed after birth. K E Y W O R D Sdouble-chambered left ventricle, echocardiography, fetus

Double-chambered Left Ventricle: Clinical Features Comparison between Children and Adults

“…23 In 20 pateints, their electrocardiographic (ECG) findings were available: the ECG findings were normal in 6 (30%) patients. 2,6,25,26,29,31 In comparison, an abnormal ECG was seen in the remaining 14 (70%) patients ( 2 =6.40, p=0.026). In the 6 patients with a normal ECG, 3 (50%) were pediatric and 3 (50%) were adult cases ( 2 =0.00, p=1.000); while 3 (21.4%) patients with an abormal ECG finding were pediatrics and 11 (78.6%) were adults ( 2 =9.14, p=0.007).…”

“…1,2, One case was a 24-week gestation fetus, whose gender was not reported. 29 For the remaining 28 patients, 20 (71.4%) were males and 8 (28.6%) were females with a male-tofemale ratio of 2.5:1. Their mean age was 28.6 ±11.7 years (n=28).…”

“…There were 10 (34.5%) pediatric patients (including the fetal case), 2,6,11,13,16,17,19,[28][29][30] and 19 (65.5%) adult patients ( 2 =5.59, p=0.035). 1,5,[7][8][9][10]12,14,15,18,[20][21][22][23][24][25][26][27]31 Fourteen patients (48.3%) were asymptomatic, 2,6,8,13,14,16,17,[22][23][24]26,27,29,31 while 15 (51.7%) were symptomatic ( 2 =0.00, p=1.000). 1,5,7,[9][10][11][12]15,…”

Double‐chambered left ventricle: An unusual finding in a middle‐aged woman

“…DCLV is an extremely rare congenital heart disease 1 . It is usually diagnosed during neonatal or pediatric age 2 and has been reported only occasionally in adults 3 . In our case, it was found to be associated with a VSD, an even rarer occurrence.…”

Echocardiographic Diagnosis of Double-Chambered Left Ventricle in an Infant

“…Diagnosis can be made by echocardiography as early as fetal life. 2 Three-dimensional imaging modalities can further aid the distinction. 3,4 We present a case of DCLV in a patient with D-transposition of the great arteries who developed progressively worsening biventricular systolic function after complete repair and was referred for cardiac transplantation.…”