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[Congenital left ventricular aneurysms and diverticula: clinical findings, diagnosis and course]
K Mayer1, R Candinas, C Radounislis
1Departement Innere Medizin, Universitätsspital Zürich.
Insights
Congenital left ventricular aneurysms and diverticula are rare conditions. Considering them in the differential diagnosis of ventricular arrhythmias and embolic events can aid timely diagnosis and management.
Area of Science:
- Cardiology
- Congenital Heart Disease
Context:
- Congenital aneurysms or diverticula of the left ventricle are rare cardiac anomalies.
- Diagnosis is often delayed, occurring after presentation with symptoms like ventricular arrhythmias or embolic events.
Purpose:
- To investigate the clinical presentation, diagnosis, and management of congenital left ventricular aneurysms and diverticula in adult patients.
- To highlight the importance of considering these rare conditions in the differential diagnosis.
Summary:
- The study analyzed 16 adult patients with congenital left ventricular aneurysms or diverticula.
- Presentations included ventricular arrhythmias and embolic events; other cardiac conditions were ruled out.
- Management strategies were tailored, including surgery, ICD implantation, ablation, and pharmacotherapy, with a generally favorable outcome.
Impact:
- This study emphasizes the need to include congenital ventricular aneurysms or diverticula in the differential diagnosis for patients with unexplained ventricular tachyarrhythmias or embolic events.
- Early and accurate diagnosis can lead to appropriate, individualized treatment and potentially prevent severe complications.
Unlabelled:
Congenital aneurysms or diverticula of the left ventricle are rare findings that can be detected by both echocardiography and/or left ventricular angiography. We investigated 16 adult patients presenting either with left ventricular aneurysms (n = 8, mean age 33 +/- 12 years) or diverticula (n = 8, mean age 53 +/- 15 years). In 6 patients the first manifestation of the disease were ventricular arrhythmias, while in the remaining 10 patients the diagnosis was established after echocardiographic examination or cardiac catheterization in search of embolic events, valvular disease or atypical chest pain. In all patients ischaemic heart disease, dilated or hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy could be ruled out. Most of the aneurysms and diverticula were localized below the mitral valve. Patients underwent surgery (n = 1), implantation of cardioverter-defibrillator ICD (n = 2), radiofrequency catheter ablation (n = 1) or drug therapy with class III antiarrhythmics or beta-adrenergic blocking agents (n = 8). Four patients are receiving long-term anticoagulation. With this individually tailored therapy a favourable outcome can be expected in most cases, although during follow-up of 61 (9-121) months one patient died from left heart failure due to amiodarone-induced hyperthyroidism; there were no cerebrovascular complications.
Conclusion:
Differential diagnosis of symptomatic ventricular tachyarrhythmias or embolic events of unknown origin should include congenital ventricular aneurysms or diverticula.