Management challenges in left ventricular diverticulum: a case with 8-year follow-up and literature review

This case represents a young, previously healthy woman with intermittent palpitations, who was found to have a left ventricular outpouching. Imaging with echocardiography and magnetic resonance revealed a mildly dilated left ventricle with a slightly reduced ejection fraction. The outpouching was characterised as a left ventricular diverticulum (LVD) as it involved all three layers of the heart wall with synergistic contraction. This is an extremely rare, usually incidentally found entity. Management is based on case reports as guideline-based therapies lack with a wide range of treatment options, from watchful waiting to surgical repair, suggesting an unmet clear management strategy. Despite slightly reduced exercise capacity, symptoms and imaging findings remained stable over a period of 8 years with medical therapy and close follow-up. We underscore the importance of adopting a cautious strategy in the management of patients with LVD. The management decision, however, remains patient-tailored, considering the type of anomaly and patient characteristics.