Congenital left ventricular aneurysms and diverticula: definition, pathophysiology, clinical relevance and treatment

Area of Science:

• Cardiology
• Developmental Biology
• Medical Imaging

Background:

• Congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation, with approximately 411 cases reported since 1816.
• This condition is considered a developmental anomaly originating in the 4th embryonic week.
• About 70% of cases are associated with other cardiac, vascular, or thoraco-abdominal abnormalities.

Purpose of the Study:

• To review the characteristics, diagnosis, and management of congenital left ventricular aneurysms and diverticula.
• To highlight the importance of differentiating this condition from acquired causes like coronary artery disease or cardiomyopathies.
• To outline the spectrum of clinical presentations and potential complications.

Main Methods:

• Diagnosis is established through exclusion of other causes (coronary artery disease, inflammation, trauma, cardiomyopathies).
• Imaging studies including echocardiography, magnetic resonance imaging, and left ventricular angiography are crucial for diagnosis.
• Review of reported cases and clinical presentations.

Main Results:

• Most congenital left ventricular aneurysms and diverticula are asymptomatic.
• Potential complications include systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia, and sudden cardiac death.
• Imaging modalities visualize structural changes and associated abnormalities.

Conclusions:

• Treatment strategies must be individualized based on clinical presentation, associated abnormalities, and complications.
• Management options range from surgical resection and anticoagulation to device implantation and antiarrhythmic drugs.
• Early and accurate diagnosis through imaging is essential for appropriate patient management.