Ventricular diverticulum

Ventricular diverticulum

Description

This is a very rare defect. It is an out-pouching in, or of, the ventricular myocardium. It may be secondary to a vascular event or to intrinsic weakness in the ventricular wall. It may affect the left or the right ventricle and is usually located at the apex. It can present with an irregular heart rhythm, with a pericardial effusion or simply as an abnormal appearance of the four chamber view. If it is causing a significant haemodynamic effect in utero the outcome is likely to be poor. It is too rare a condition to have a clear indication of the prognosis if there are no haemodynamic effects but the outlook should be guarded.

Diagnosis

The four chamber view will be abnormal due to distortion of the ventricular shape, with the defect in the ventricular wall ‘bulging’ into the pericardial sac. The ‘bulge’ will fill with blood on colour flow mapping. An associated pericardial effusion may be large. The function of the affected ventricle may be compromised as evidenced by decreased inflow and outflow on colour flow mapping and reduced contraction. There may be multiple ectopic beats.

Differential Diagnosis

If ventricular function is severely compromised the underlying diagnosis of ventricular diverticulum may be overlooked. Similarly, it may be overlooked in the presence of a large pericardial effusion.

Sonographic Features

Defect of the myocardial wall with a bulging protrusion into the pericardial sac.

Diverticulum usually apical.

Often ectopy.

Often pericardial effusion, may be large.

Less commonly, ventricular dysfunction.

Associated Syndromes

References

Anderson RH, McCartney FJ, Shinebourne EA, Tynan M (Eds) In: Paediatric Cardiology Churchill Livingstone: Edinburgh, p1057-1073
Allan LD, Sharland GK, Milburn A, Lockhart SM, Groves AMM, Anderson RH, Cook AC, Fagg NLK Prospective diagnosis of 1,006 consecutive cases of congenital heart disease in the fetus J Am Coll Cardiol 23:1452-8
Kitchiner D, Leung MP, Arnold R Isolated congenital left ventricular diverticulum: echocardiographic features in a fetus Am Heart J 119:1435-7
Hornberger LK, Dalvi B, Benacerraf BR Prenatal sonographic detection of cardiac aneurysms and diverticula J Ultrasound Med 13:967-70