Imaging in cardiology M.J.M. Cramer and W. Jaarsma, editors
Left ventricular diverticulum
A 69-year-old man with known stable chronic glomerulonephritis was admitted due to unstable angina pectoris. Cardiac catherterisation demonstrated a left ventricular diverticulum located on the posterobasal wall with narrow connection to the left ventricular cavity (figure 1). Coronary angiography revealed significant obstructive three-vessel disease. The patient underwent successful coronary artery bypass surgery. A congenital left ventricular diverticulum (LVD) is a relatively rare cardiac anomaly and has to be differentiated from an aneurysm or a localised herniation through a partial pericardial defect. Histologically, congenital diverticula are divided into two types: muscular and fibrous. Clinically, they can be differentiated by their contractile properties, namely that the muscular type has normal contraction and the fibrous type has paradoxical motion during systole. The diagnosis of LVD is made by two-dimensional echocardiography and contrast angiography.'" In one patient, an acquired aetiology (infection, traumatic, or tumour) of the diverticulum was ruled out, confirming the diagnosis of a congenital LVD. In 70% of patients with LVD there are associated midline thoracoabdominal defects or other congenital cardiac malformations such as ventricular septal defect (VSD), atrial septal defect (ASD), or persistent ductus arteriosus (PDA). It has been reported that LVD could be associated with ventricular fibrillation and sudden cardiac death.3 Furthermore, atrial fibrillation and congestive heart failure in the presence of LVI) have been documented.4 In our case, no such abnormalities were present. *
S.A.M. Said, Hospital SMT, Hengelo. References 1
Esteves CM, Weyman AE, Feigenbaum H. Detection of left ventricular diverticulum by cross sectional echocardiography. Chest 1976;69:544.
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Figure 1. Left ventricular cineangiogram in right anterior oblique (RAO) projection outlined a normal left ventricular size and contractility and a pouch (arrow) arisingfrom the posterobasal wall with narrow connection to the ventricular cavity. 2 3 4
Baltaxe HA, Wilson WJ, Amiel M. Diverticulosis of the left ventricle. AmJRoentgenol 1979;133:257. Speechly-Dick ME, Oliver RM, Slapak GI. Congenital left ventricular diverticula: a rare cause ofsudden cardiac death. Post,grad MedJ 1992;68:378-80. Ichikawa K, Makino K, Futagami Y, et al. Isolated congenital left ventricular diverticulum in an adult. A case report. Angiology 1994;45:743-7.
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands.
Nctherlands Heart Journal, Volume 9, Number 6, September 2001
Left ventricular diverticulum
A 69-year-old man with known stable chronic glomerulonephritis was admitted due to unstable angina pectoris. Cardiac catherterisation demonstrated a left ventricular diverticulum located on the posterobasal wall with narrow connection to the left ventricular cavity (figure 1). Coronary angiography revealed significant obstructive three-vessel disease. The patient underwent successful coronary artery bypass surgery. A congenital left ventricular diverticulum (LVD) is a relatively rare cardiac anomaly and has to be differentiated from an aneurysm or a localised herniation through a partial pericardial defect. Histologically, congenital diverticula are divided into two types: muscular and fibrous. Clinically, they can be differentiated by their contractile properties, namely that the muscular type has normal contraction and the fibrous type has paradoxical motion during systole. The diagnosis of LVD is made by two-dimensional echocardiography and contrast angiography.'" In one patient, an acquired aetiology (infection, traumatic, or tumour) of the diverticulum was ruled out, confirming the diagnosis of a congenital LVD. In 70% of patients with LVD there are associated midline thoracoabdominal defects or other congenital cardiac malformations such as ventricular septal defect (VSD), atrial septal defect (ASD), or persistent ductus arteriosus (PDA). It has been reported that LVD could be associated with ventricular fibrillation and sudden cardiac death.3 Furthermore, atrial fibrillation and congestive heart failure in the presence of LVI) have been documented.4 In our case, no such abnormalities were present. *
S.A.M. Said, Hospital SMT, Hengelo. References 1
Esteves CM, Weyman AE, Feigenbaum H. Detection of left ventricular diverticulum by cross sectional echocardiography. Chest 1976;69:544.
244
Figure 1. Left ventricular cineangiogram in right anterior oblique (RAO) projection outlined a normal left ventricular size and contractility and a pouch (arrow) arisingfrom the posterobasal wall with narrow connection to the ventricular cavity. 2 3 4
Baltaxe HA, Wilson WJ, Amiel M. Diverticulosis of the left ventricle. AmJRoentgenol 1979;133:257. Speechly-Dick ME, Oliver RM, Slapak GI. Congenital left ventricular diverticula: a rare cause ofsudden cardiac death. Post,grad MedJ 1992;68:378-80. Ichikawa K, Makino K, Futagami Y, et al. Isolated congenital left ventricular diverticulum in an adult. A case report. Angiology 1994;45:743-7.
In this section a remarkable 'image' is presented and a short comment is given. We invite you to send in images (in triplicate) with a short comment (one to two pages at the most) to Mediselect bv, Editorial Office Netherlands Heart Journal, PO Box 63, 3830 AB Leusden, the Netherlands.
Nctherlands Heart Journal, Volume 9, Number 6, September 2001
