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European Heart Journal Advance Access originally published online on March 29, 2007
European Heart Journal 2007 28(8):1040-1041; doi:10.1093/eurheartj/ehm041
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Role of magnetic resonance with delayed contrast enhancement imaging in the diagnosis of congenital ventricular outpouching: reply

Eduardo da Cruz

Cardiac Intensive Care Unit
The Heart Institute
Section of Pediatric Cardiology
Department of Pediatrics
The Children's Hospital of Denver and University of Colorado at Denver and Health Sciences Center (UCDHSC)
1056 East 19th Avenue
Pediatric Cardiology B100
Denver
CO 80218
USA
E-mail address: Dacruz.Eduardo{at}tchden.org

Cécile Tissot

The Heart Institute, Section of Pediatric Cardiology
Department of Pediatrics
The Children's Hospital of Denver
CO 80218
USA

We read with great interest the letter to the editor from Marijon and Redheuil1 entitled ‘Non-invasive "tissue characterization approach" for congenital ventricular outpouchings: role of magnetic resonance with delayed contrast enhanced imaging’ with regard to our recent clinical vignette concerning ‘A giant congenital left ventricular diverticulum simulating an aneurysm’.2

The authors draw the attention to very important and useful aspects concerning the diagnosis of congenital left ventricular aneurysms and diverticula.

We definitely agree that ideally, identification of ventricular outpouching anomalies is established by imaging studies, among which magnetic resonance imaging (MRI) is the reference,1,3,4 particularly with regard to the differential diagnosis between aneurysm and diverticula. MRI allows tissue characterization, precisely evaluates morphological and functional features, and clearly differentiates areas of fibrosis. In selected cases, it might also be instrumental for the differentiation of this disorder from right ventricular dysplasia with spreading to the left ventricle due to the good visualization of fatty or fibrous infiltration of the left myocardium.5

Nevertheless, there are still significant limitations from a practical standpoint. First, the significance of MRI in the diagnosis of congenital left ventricular aneurysm or diverticula still needs to be exactly defined and a uniform classification system to compare the clinical presentation, morphology, and prognosis needs to be established.6 Secondly, the very low incidence of congenital left ventricular outpouchings does not easily allow a learning curve experience in the evaluation of MRI imaging for this specific anomaly. Last, but not least, because of its limited availability in developing countries and also in more privileged professional environments, MRI has not yet been established as a routine tool. This particularity grants a significant importance to the clinical and echocardiographic attempts to adequately classify congenital left ventricular outpouchings. Medical practitioners in such environments must therefore be aware of the aforementioned limitations and the likelihood of misdiagnosing the nature of the outpouching.

References

  1. Marijon E and Redheuil A. (2007) Non-invasive "tissue characterization approach" for congenital ventricular outpouchings: role of magnetic resonance with delayed contrast enhanced imaging. Eur Heart J.[Free Full Text]
  2. Tissot C, Claude PJ, da Cruz E. (2007) A giant congenital left ventricular diverticulum simulating an aneurysm. Eur Heart J 28:25.[Free Full Text]
  3. Marijon E, Ou P, Fermont L, Concordet S, Le Bidois J, Sidi D, Bonnet D. (2006) Diagnosis and outcome in congenital ventricular diverticulum and aneurysm. J Thorac Cardiovasc Surg 131:433–437.[Abstract/Free Full Text]
  4. Heatlie GJ and Mohiaddin R. (2005) Left ventricular aneurysm: comprehensive assessment of morphology, structure and thrombus using cardiovascular magnetic resonance. Clin Radiol 60:687–692.[CrossRef][Web of Science][Medline]
  5. Mayer K, Candinas R, Radounlis C, Jenni R. (1999) Kongenitale linksventrikuläre Aneurysmen und Divertikel: Klinik, Diagnostik und Vertauf. Schweiz Med Wochenschr 129:1249–1256.[Web of Science][Medline]
  6. Ohlow MA. (2006) Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment. Cardiology 106:63–72.[Medline]

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This Article
Right arrow FREE Full Text (PDF) Freely available
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