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A giant congenital left ventricular diverticulum simulating an aneurysm

Cécile Tissot, Jean Claude Pache, Eduardo da Cruz
DOI: http://dx.doi.org/10.1093/eurheartj/ehl083 25 First published online: 13 June 2006

A 9-year-old male patient was referred to our institution with mild symptoms and signs of cardiac failure. Magnetic resonance imaging confirmed the echocardiographic suspicion of a giant left ventricular outpouching considered as an aneurysm, communicating with the left ventricle by a very large neck and exhibiting a paradoxal motion. We performed a successful surgical excision of the pouch with a Foto-Fix® patch reconstruction of the free left ventricular wall.

Histological examination of the resected pouch revealed the presence of preserved myocardial layers throughout the mass allowing us to rectify the diagnosis: as a matter fact, this was a diverticulum rather than an aneurysm.

The main described differences between congenital diverticulum and aneurysms are, respectively, a short communicating ‘collet’, well-differentiated muscular layers, and a synchronous contraction with the ventricular mass for the first and a large collet, absent muscular layer, and paradoxal motion in the latest. Moreover, congenital left diverticulum is often associated with congenital cardiac defects or with Cantrell pentalogy in around 70%, whereas aneurysms are isolated findings. Aneurysms seem to be associated with poor prognosis, whereas diverticulum often have a good outcome. For the above reasons, our patient was classified as having a congenital left ventricular aneurysm. However, after resection, the histological findings confirming the presence of all myocardial layers led us to conclude that this anomaly was in fact a diverticulum regardless of the aneurismal characteristics. Although this conclusion would not have had any therapeutic impact, this case raises an interesting issue regarding criteria for classification of such patients, which might have an effect on information provided by practitioners to patient's relatives.

The authors would like to thank Professor Dominique Didier for the MRI images.

MRI images. Massive left ventricular ‘aneurysm’ shown on spin-echo and cine magnetic resonance images. An, aneurysm; LV, left ventricle; RV, right ventricle; Ao, Aorta; Arrows, aneurismal wall.

Pathological findings on the resected outpouching: Panel A. Macroscopic view of the diverticulum.

Panel B. Histology of the diverticulum wall showing myocardial fibres (black arrow) surrounded by a dense network of collagen fibres. Asterisk indicates the Masson Trichrome stain (original magnification 1 ×).

Panel C. Magnification of a region of the wall: striated myocardial fibres (haematoxylin–eosin stain, original magnification 1000 ×).

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