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European Heart Journal Advance Access originally published online on June 2, 2006
European Heart Journal 2006 27(24):2928; doi:10.1093/eurheartj/ehl061
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

MRI findings of small isolated congenital left ventricular diverticulum

Matteo Renzulli*, Luigi Lovato and Rossella Fattori

Department of Radiology, Cardiovascular Unit, Sant'Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna 40100, Italy

* Corresponding author. Tel: +39 3290475687; fax: +39 051349797. E-mail address: dr.matteo.renzulli{at}gmail.com

A 37-year-old man was studied for chest pain. No abnormal findings were noted in clinical examination and chest X-rays. The electrocardiogram showed sinus rhythm of 64 bpm and ST-abnormalities (ST-T elevation) in the inferior and precordial leads. Coronary angiography was normal and left ventricular angiography revealed normal ejection fraction and a small finger-like shaped image at the inferior wall. There was not a good echocardiographic acoustic window. The patient was submitted to MRI exam in order to better define the unusual aspect. The study clearly defined a small isolated diverticulum located at mid-inferior segment of left ventricular wall [short (Panel A) and long-axis (Panel B) spin-echo image]. On dynamic images, it appeared as muscular type because of changing during cardiac contraction, with maximum diameter in diastolic phase and complete emptying during systole [dynamic cardiac images in diastole (Panels C–E) and in systole (Panels C'–E'; movies 1–3)]. No abnormality was noted both in perfusion phase post-gadolinium and in delayed images at 5–10–15–20 min. Medical therapy including cardioaspirin and beta-blocker was given and a close follow-up (3–6 months) with MRI was planned.

In conclusion, MRI allows a complete assessment of congenital left ventricular diverticulum (LVD) identifying fibrous or muscular type and relationship with other cardiac structures. Because of its non-invasive nature and parameter reproducibility, MRI alone can provide excellent monitoring of LVD follow-up in patient treated with conservative approach.

Panel A. Short-axis spin-echo image.

Panel B. Long-axis spin-echo image.

Panels C–E. Dynamic cardiac images in diastole.

Panels C'–E'. Dynamic cardiac images in systole.

Supplementary movie is available at European Heart Journal online.

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This Article
Right arrow Full Text (PDF)
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Right arrow All Versions of this Article:
27/24/2928    most recent
ehl061v1
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Right arrow Articles by Renzulli, M.
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