A congenital isolated left ventricular apical diverticulum simulating a tako-tsubo
Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.Chinese medical journal (Impact Factor: 1.05). 01/2011; 124(2):315-7. DOI: 10.3760/cma.j.issn.0366-6999.2011.02.030
Left ventricular diverticulum is a rare congenital anomaly of which the incidence was reported to be 0.26%. Diverticula are usually localized near the apex and most often involve the inferior or anterior parietal walls of the left ventricle. In this report, we describe a rare case of congenital isolated left ventricular apical diverticulum, which was tako-tsubo-like in systole, "dumbbell-like" the whole left ventricle, diagnosed by angiography and magnetic resonance imaging. Chin Med J 2011;124(2):315-317
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ABSTRACT: Background: Ventricular diverticulum (VD) is a rare cardiac malformation. The surgical indications for VD remain controversial. This review is designed to determine the demographic characteristics, diagnosis, and surgical indications of this disease. Methods: Using PubMed and the Chinese electronic databases CNKI, WANFANG, and VIP, a computerized search was performed of the literature from China published between March 1965 and July 2012. Major risk factors for developing VD complications were confirmed by logistic regression analysis in case-control studies. Results: Ninety-three articles and 127 VD patients were identified in this literature review. VDs can lead to aortic insufficiency, thrombosis, infective endocarditis, heart failure, diverticular rupture, ventricular arrhythmia, and cerebral embolism. In patients with VD complications, 92.3% were men (OR = 6.43, 95% CI = 1.23-33.53), 84.6% of the patients had a fibrous type VD (OR = 10.54, 95% CI = 2.86-38.85), and 48.0% of the cases were subaortic diverticulum (SD) related (OR = 6.41, 95% CI = 1.17-35.19). Conclusions: VD can result in rupture, cerebral embolism, heart failure, ventricular arrhythmia, infective endocarditis, thrombosis and aortic insufficiency. Male gender, fibrous type, and SD are three major independent risk factors for developing VD complications. Surgical resection should be performed in those VD patients with risk factors for major complications.
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ABSTRACT: Background Congenital left ventricular outpouchings (LVOs) are reported under five overlapping and poorly defined terms including left ventricular accessory chamber, left ventricular aneurysm (LVA), left ventricular diverticulum (LVD), double-chambered LV, and accessory left ventricle. Diagnostic criteria are frequently mixed and not mutually exclusive. They convey no information regarding treatment strategy and prognosis.Objectives The aim of this systematic review is to provide a clear and inclusive classification, with therapeutic and prognostic implications, for congenital LVOs.Data sourcesWe performed three separate sets of search on three subjects including “congenital left ventricular outpouchings,” “important and simply measurable markers of left ventricular function,” and “relationship of mechanics of intraventricular blood flow and optimal vortex formation in left ventricle and elliptical geometry of LV.”Study eligibility criteriaWe enrolled case series, review articles, and case reports with literature review. All types of acquired LVO's were excluded.Study appraisal and synthesis methodsWe studied the abstracts of all searched articles. We focused on diagnostic criteria and patients' outcome. To examine the validity and reliability of the novel classification, fifteen previous studies were revisited using the novel classification.ResultsA total of 20 papers from 11 countries fulfilled our inclusion criteria. The age of patients ranged from prenatal age to geriatric age range. Diagnostic criteria were clearly stated only for two of the above five terms (i.e., congenital LVA and congenital LVD). Cases with mixed diagnostic criteria were frequent.Elliptical geometry of left ventricle was found to have significant impact on effective blood flow mechanics in LV. A simple inclusive classification for congenital LVOs, with therapeutic and prognostic implications, was introduced.Conclusion The cornerstone of this classification is elliptical LV geometry. Large-type IIc LVO have dismal prognosis, if left untreated. LVO type I and small LVO type IIa have the best prognosis.
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ABSTRACT: Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04). LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.