Congenital Left Ventricular Diverticulum

(J Am Soc Echocardiogr 2011;24:109.e5-109.e7.)

A full-term female newborn was noted to have a pulsatile abdominal mass .
By auscultation, her cardiac examination was normal, and she was acyanotic. A pulsatile mass that originated from the inferior portion of the sternum was seen extending along the abdominal
midline to the umbilicus. The sternum was intact by palpation. The apex of the pulsatile mass was attached to the umbilical cord by a fibrous strand

Transthoracic echocardiography showed mesocardia with a pulsatile mass originating from the LVapex extending toward the abdomen . By color Doppler, there was unrestricted to-andfro
flow into the diverticulum. The remainder of the intracardiac anatomy was normal, with the exception of a small patent foramen ovale and a patent ductus arteriosus

To better define the tissue characteristics and extent of the mass, cardiac magnetic resonance (CMR) imaging was performed and revealed a long tubular diverticulum arising from the LV apex, which then exited the thoracic cavity at the inferior aspect of the sternum. It then coursed anterior to the abdominal musculature, terminating in a blind pouch approximately 1cm cephalad to the umbilicus. The diverticulum measured 5 cm in length and 8 mm in its widest dimension.
The LVentrance of the diverticulum measured 6 mm. The entire length of the diverticulum was contractile, without any evidence of thrombus or dyskinesia (Figures 3A and 3B). The patient was referred for surgical resection of the diverticulum in light of the potential for traumatic rupture or thrombus formation

A                                           B

 

 Transthoracic two-dimensional echocardiographic and Doppler imaging. (A) Two-dimensional imaging shows a diverticulum (arrow) originating from the left ventricular apex (arrow). (B) Color Doppler imaging shows unrestricted to-and-fro flow into the diverticulum (arrow). LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

 

Pulsatile abdominal mass.The diverticulum is tethered at its apex to the umbilical cord by Fibrous tissue (arrow)..

CMR imaging of the left ventricular diverticulum (arrow). (A) Black-blood (spin-echo) imaging in the sagittal plane shows an elongated, large diverticulum originating from the left ventricular apex and coursing anterior to the abdominal wall. (B) Postgadolinium magnetic resonance angiographic imaging and 3-dimensional reconstruction shows the entire length of the diverticulum and its relation to other cardiac structures. LV, Left ventricle; RV, right ventricle.

Intraoperative appearance of the diverticulum prior to resection. (A) The surgically isolated diverticulum measured 7 cm in length (arrow). (B) Three pledgeted sutures are placed at the base of the diverticulum immediately prior to resection (arrow). LV, Left ventricle.