Introduction: Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. We report the case of a boy with congenital left ventricular apical diverticulum diagnosed incidentally.
Case presentation: A 13-years old boy, without a family history of congenital heart disease was referred to our institute with progressively increasing symptoms of dyspnoea of 2 years` duration. Prior to that he did not suffer from any exertional intolerance, chest pain, palpitations, dyspnoea, syncope, or presyncope. His medical history was negative.
Cardiac examination revealed a regular rhythm with continuous murmur grade 2/6, noted at the apex. Electrocardiogram showed normal sinus rhythm with poor precordial R-wave and with incomplete right bundle branch block.
Chest radiography revealed cardiomegaly that chiefly involved the LV, and a prominent localized bulge at its apex. An echocardiogram showed normal cardiac connections, normal ventricular size and function, dimensions and wall thickness. However the examination revealed an aneurysm of 4.5 x 4.3 cm diameter, in the inferoapical/apical–lateral walls of the LV, with systolic inflow and diastolic outflow. Wall-motion analysis showed that the muscle of the chamber thickened during systole. No thrombus was seen. Aortic valve was bicuspid without any haemodynamic disturbances.
Discussion: Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic, but some of them may cause systemic emboli, 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, by visualization of the structural changes and accompanying abnormalities. The mode of treatment has to be individually tailored and depends on the clinical presentation, accompanying abnormalities and possible complications. Options include surgical resection, especially in symptomatic patients, anticoagulation after occurrence of systemic emboli, radiofrequency ablation or implantation of a cardioverter defibrillator in case of symptomatic ventricular tachycardias, occasionally combined with class I or III antiarrhythmic drugs. Because of the usually benign course of congenital left ventricular aneurysms and diverticula in adulthood, most of them can be managed conservatively.
Key words: Left ventricular diverticulum, Cantrell’s pentalogy, Echocardiography
