European Heart Journal Advance Access originally published online on March 29, 2007
European Heart Journal 2007 28(8):1040; doi:10.1093/eurheartj/ehm042
Non-invasive ‘tissue characterization approach’ for congenital ventricular outpouchings: role of magnetic resonance with delayed contrast-enhanced imaging
Department of Cardiology
Georges Pompidou European Hospital
20 rue Leblanc
75015 Paris
France
Tel: +33 1 56 09 37 31
Fax: +33 1 56 09 37 29
E-mail address: eloi_marijon{at}yahoo.fr
Department of Cardiovascular Radiology
Georges Pompidou European Hospital
Paris
France
We read with great interest the recent clinical vignette of Tissot et al.1 The authors reported the case of a congenital apical ventricular outpouching in a 9-year-old child, referred with mild symptoms of cardiac failure. Absence of active contraction with paradoxical motion and the large neck have been strong arguments in favour of a congenital ventricular aneurysm (CVA). However, the final diagnosis was congenital ventricular diverticulum (CVD) in view of the histological examination showing the three preserved myocardial layers. Nevertheless, although the authors illustrated nicely the morphological and functional information available with MRI, we take the opportunity to stress the potential role of MRI in the diagnosis of fibrosis within these congenital ventricular outpouchings.
Although various characteristics have been proposed to differentiate CVA from CVD, definition remained incomplete and confusing.2 Recent reports tend to clarify this point.3 We may classify congenital ventricular outpouchings into two entities.3 The preservation of contractility defines a CVD, taking form from either the ventricular apex (Cantrell syndrome)4 or a non-apical part of the ventricle, usually larger with wide connection to the ventricle. On the contrary, if the outpouching is akinetic or dyskinetic because of a fibrous wall, it corresponds to either a CVA or a CVD with fibrotic evolution. Furthermore, dyskinesia or akinesia and fibrosis are known to be strong predictors of poor outcome in congenital ventricular outpouchings.3
MRI is the most accurate available tool to illustrate parietal fibrosis, using delayed contrast enhancement imaging.3,5,6 MRI may play an interesting role in differentiating fibrotic from non-fibrotic outpouchings, in addition to a precise evaluation of morphological features and characterization of loco-regional contraction.
The case of Tissot et al. well illustrates the complexity of congenital ventricular outpouchings by describing a CVD with fibrosis. Thanks to its ‘tissue characterization approach’, MRI may help in clarifying the outcome of ventricular outpouchings by identifying those with or without fibrosis.
References
- Tissot C, Pache JC, Da Cruz E. (2007) A giant congenital left ventricular diverticulum simulating an aneurysm. Eur Heart J 28:25.
[Free Full Text] - Krasemann T, Gehrmann J, Fenge H, Debus V, Loeser H, Vogt J. (2001) Ventricular aneurysm or diverticulum? Clinical differential diagnosis. Pediatr Cardiol 22:409–411.[CrossRef][Web of Science][Medline]
- Marijon E, Ou P, Fermont L, Concordet S, Le Bidois J, Sidi D, Bonnet D. (2006) Diagnosis outcome in congenital ventricular diverticulum aneurysm. J Thorac Cardiovasc Surg 131:433–437.
[Abstract/Free Full Text] - Marijon E, Hausse-Mocumbi AO, Ferreira B. (2006) Cantrell's syndrome. Cardiol Young 16:95–96.[CrossRef][Web of Science][Medline]
- Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, Sheppard MN, Poole-Wilson PA, Pennell DJ. (2006) Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 48:1977–1985.
[Abstract/Free Full Text] - Kim RJ, Wu E, Rafael A, Chen EL, Parker MA, Simonetti O, Klocke FJ, Bonow RO, Judd RM. (2000) The use of contrast enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med 343:1445–1453.
[Abstract/Free Full Text]
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