Left ventricular
pseudo-aneurysm complicating a ruptured isolated congenital
diverticulum
Liang Fang MD.1, Chao Xue MD.2, Ying
Zhao PhD, MD2, Zhaoying Wen PhD,
MD3, Michel Y Henein MSc, PhD, FESC4
- Department of Ultrasound, South
Hospital District of Affiliated Hospital of Chengde Medical College,
Chengde, Hebei, China
- Department of Echocardiography,
Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Radiology, Beijing
Anzhen Hospital, Capital Medical University, Beijing, China
- Institute of Public Health and
Clinical Medicine, Umeå University, Umeå, Sweden.
Running title: A ruptured congenital left ventricular diverticulum
Corresponding Author
Michael Henein MSc PhD FESC
Professor of Cardiology
Department of Public Health and Clinical Medicine
Umeå University, Umeå, Sweden
michael.henein@umu.se
Tel: +46907850000 Fax: +4690137633
Abstract :We report a
case of 41-year-old woman who presented with chest tightness and
shortness of breath. Transthoracic echocardiogram (TTE) showed left
ventricular (LV) pseudo-aneurysm of the inferior wall with preserved LV
systolic function. Coronary angiogram was normal. Surgical repair of the
pseudo-aneurysm with a pericardial patch was performed, and pathological
results confirmed rupture of an isolated congenital LV diverticulum.as
the most likely etiology.
Keywords : left
ventricular, pseudo-aneurysm, diverticulum
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.
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. A transthoracic echocardiography (TTE) showed
20 mm discontinuity (with narrow connection neck) of basal segment of
the inferior wall with 88 × 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 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 2A & 2B).
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 3). 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.