Introduction
Congenital left ventricular (LV)
diverticulum is a rare cardiac anomaly which can be complicated with
infective endocarditis, embolisms, arrhythmia and, rarely, rupture1-4 . If ruptured, the outcome is usually poor with
high mortality. We report a case of LV pseudo-aneurysm with ruptured
diverticulum and successful surgical repaired.
A 41-year-old woman presented with a history of chest tightness and
shortness of breath for 6 months. On clinical examination, blood
pressure was 124/86 mmHg. The ECG showed sinus rhythm without evidence
for ischemic changes, and chest X-ray revealed an enlarged heart. A
transthoracic echocardiography (TTE) showed 20 mm discontinuity (with
narrow connection neck) of basal segment of the inferior wall with 88 mm
× 71 mm echo-free space, suggesting pseudo-aneurysm formation wrapped
within the pericardial (Fig 1A). There was a marked thrombus in the
pseudo-aneurysm with large pericardial effusion (Fig 1B). Color Doppler
demonstrated blood flow across the narrow neck of the pseudo-aneurysm
(Fig 1C). Overall LV systolic function was preserved with no other
combined abnormality.
The patient did not have any history of myocardial infarction, prolonged
fever, chest trauma or any cardiac surgery. Coronary angiogram confirmed
normal coronary arteries (Fig 2A & 2B), and cardiac magnetic resonance
imaging (MRI) confirmed the presence of the LV pseudo-aneurysm, on late
gadolinium enhancement (LGE) showing LV pseudo-aneurysm with thin wall
corresponding to fibrosis and/or scar (Fig 3A & 3B).
The patient underwent surgery, during which a large pseudo-aneurysm of
LV inferior wall was confirmed with a thrombus inside. The
pseudo-aneurysm was closely adherent to the pericardium of the
diaphragmatic surface (Fig 4). Surgical repair with a pericardial patch
was performed, and postoperative TTE showed normal LV function with the
patch located at the inferior wall. Pathological investigations showed
the aneurysm size was 70 × 60 × 35 mm. Based on the imaging,
pathological results and medical history we considered that the
ventricular aneurysm was a congenital LV diverticulum, which ruptured
and caused a ventricular pseudo-aneurysm.