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Diverticulum of the left ventricle in hypertrophic cardiomyopathy
Insights
A rare case of left ventricular diverticulum in a 65-year-old patient is presented. Surgical intervention successfully improved ventricular function by releasing an obstructive mid-ventricular contraction ring.
Area of Science:
- Cardiology
- Cardiac Surgery
- Pathology
Background:
- Left ventricular diverticulum is a rare congenital or acquired cardiac anomaly.
- Mid-ventricular obstruction is an uncommon cause of cardiac dysfunction.
Observation:
- A 65-year-old patient presented with an unusual left ventricular diverticulum.
- Histologic examination revealed a circumferential mid-ventricular contraction ring with features similar to asymmetric septal hypertrophy.
- This ring obstructed apical emptying, creating a diverticulum and diminishing overall ventricular volume.
Findings:
- The mid-ventricular hypertrophy impaired papillary muscle function, leading to mitral valve prolapse and mitral regurgitation.
- The patient, diagnosed at 65, is likely the oldest reported case of ventricular diverticulum.
- Surgical transapical myotomy and myectomy of the contraction ring increased effective ventricular volume.
Implications:
- This case expands the understanding of ventricular diverticulum and its association with hypertrophic cardiomyopathy.
- Surgical correction of mid-ventricular obstruction can be effective in managing this rare condition.
- Further research is needed to clarify the relationship between ventricular diverticula, aneurysms, and hypertrophic cardiomyopathy.
Abstract:
An unusual case of diverticulum of the left ventricle is presented. The most distinctive feature was the presence of a circumferential mid-ventricular contraction ring with histologic abnormalities similar to those described in patients with asymmetric septal hypertrophy. This abnormal ring of tissue obstructed emptying of the ventricular apex and isolated it from the rest of the ventricle. The obstructed apex assumed the appearance of a muscular diverticulum, and the residual portion of the ventricle was markedly diminished in volume. In addition, the abnormal mid-ventricular hypertrophy interfered with papillary muscle function, producing mitral valve prolapse and mitral regurgitation. The patient's age was equally unusual; she was 65 at the time of diagnosis, probably the oldest known patient with ventricular diverticulum. She was treated surgically by transapical myotomy and myectomy of the mid-ventricular contraction ring, in order to increase effective ventricular volume. The relationship of this entity to other types of ventricular deiverticula and aneurysms, and to hypertrophic cardiomyopathy, is discussed.