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Coronary anomaly with a left ventricular accessory chamber: Is it left ventricular aneurysm or diverticulum?

Prashanth Panduranga1, Abdullah Amour Al-Riyami

  • 1Department of Cardiology, Royal Hospital, Muscat, Oman.

Journal of the Saudi Heart Association
|August 21, 2013
PubMed

Insights

A patient suspected of post-myocardial infarction left ventricular aneurysm was diagnosed with a left ventricular diverticulum and anomalous coronary arteries. This case highlights the need for thorough clinical and echocardiographic evaluation.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiac Surgery

Background:

  • A 60-year-old male with hypertension was initially suspected of having a post-myocardial infarction left ventricular aneurysm based on an external transthoracic echocardiogram.
  • The patient presented with findings that prompted further investigation, including coronary angiography.

Purpose of the Study:

  • To investigate the diagnostic discrepancy regarding a suspected left ventricular aneurysm.
  • To accurately diagnose cardiac abnormalities in a patient with complex coronary artery disease and atypical echocardiographic findings.

Main Methods:

  • Coronary angiography was performed to assess coronary artery anatomy and disease.
  • A repeat transthoracic echocardiogram was conducted for detailed cardiac structure and function evaluation.
  • Electrocardiogram (ECG) was utilized to evaluate for signs of post-infarct aneurysm.

Main Results:

  • Coronary angiography revealed anomalous coronary arteries and coronary artery disease.
  • The repeat transthoracic echocardiogram identified an accessory chamber on the mid-inferior wall, synchronously contracting with the left ventricle, consistent with a diverticulum, not an aneurysm.
  • The electrocardiogram showed no features indicative of a post-infarct aneurysm.

Conclusions:

  • The case underscores the importance of a comprehensive clinical assessment and detailed echocardiographic examination.
  • A broad differential diagnosis is crucial for distinguishing between conditions like left ventricular aneurysm and diverticulum.
  • Accurate diagnosis is essential for appropriate patient management, especially in the presence of anomalous coronary arteries and coronary artery disease.

Keywords:
Coronary anomalyLeft ventricular aneurysmLeft ventricular diverticulum

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