Interventricular septal diverticulum and rheumatic mitral valve disease identified and managed concurrently in middle...

Cardiac diverticula represent an extremely rare but serious cause of cardiac morbidity and mortality. They can result to arrhythmia, sudden cardiac death and ventricular dysfunction but may have no pathological implications. Here is a case of a 60-year-old Maori farmer with both rheumatic mitral valve disease and left ventricular (LV) septal diverticulum. The requirement for mitral valve replacement raised the complex decision of whether to undergo concurrent diverticulum repair. The haemodynamic significance of the diverticulum was impossible to ascertain, although we could not in good conscience leave such a large diverticulum with potential to influence further systolic deterioration. Three months after the procedures, the patient developed severe tricuspid regurgitation which is a first reported association postseptal diverticulum repair. The case highlights that careful consideration is required in repairing LV septal diverticula and an emphasis should be placed on complications and the requirement for repeat surgery during the consent process.