Quad aortic cuspid

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. 

                              

accessory mitral valve

Clinical History:A 30-year-old asymptomatic female is referred for transthoracic imaging as part of an evaluation of a family history of sudden cardiac death. Her examination is benign, she has no murmurs. The electrocardiogram is normal. Her ultrasound images are shown below.

A parasternal long axis image in mid-diastole demonstrating the left atrium (LA), left ventricle (LV) and a serpiginous membrane between the anterior and posterior mitral valve leaflet (arrows). Color flow examination and pulsed Doppler examination (not shown) failed to demonstrate either significant mitral regurgitation or stenosis

Unroofed coronary sinus

 

One of atrial septal defect types is Unroofed coronary sinus

what is mitral

The mitral valve. The mitral (left atrioventricular or bicuspid) valve is so named because of its resemblance to a cardinal’s hat, known as a mitre. Left: Photo of Pope John Paul II from
the Vatican web site

echo shows severe LV Hypertrophy , ECG is low voltage

echo shows severe LV Hypertrophy , ECG is low voltage

ECG of cardiac arrest

Two different cases of cardiac arrest

Is there ST elevation?

This 51 yo male complained of chest pain, then had a v fib arrest. He was resuscitated and brought to the ED where this ECG was recorded. He was in cardiogenic shock

There is tachycardia, and there is a wide complex. This wide complex tachycardia could easily be misdiagnosed as V tach. However, there are p-waves, and this is a classic RBBB + LAFB (left anterior fascicular block) morphology. When V tach originates in the left ventricle, there may be an RBBB-like complex, but because VT originates in the myocardium, not in the left bundle (as does RBBB), it does not look exactly like RBBB, as this one does. The left anterior fascicular block can be diagnosed by the left axis deviation. RBBB alone would have S-waves in I and aVL; since there are late large R-waves, there is LAFB.

So now we can say it is sinus tach with RBBB + LAFB

Is there ST elevation?

 

What is that ECG Diagnosis

A case with history of syncope