[Left ventricular basal fibrous myocardial aneurysm in a 3-week-old girl]

A congenital bulging of the myocardial wall is a rare finding; little is known about its etiology and clinical course. The case of a 3-week-old girl in whom rapidly progressive cardiac insufficiency occurred after a completely normal postnatal development is described. Selective ventricular angiography revealed ventricular malfunction and an akinetic area occupying 57% of the basal free left ventricular wall. The child died in acute cardiac failure. Autopsy disclosed a basal fibrous aneurysm which extended to 34% of the free ventricular wall. There was no indication of a coronary or inflammatory etiology, so a focal disorder of myocardial architecture was presumed. Congenital bulging of the ventricular wall can be divided into broad-based aneurysms and diverticula, the latter being connected with the ventricle by a small orificium. A further distinction can be made on the basis of localization and histology. A reclassification of the congenital bulging of the left ventricular wall presented in the literature showed that apical muscular diverticula are the most frequent, whereas only four cases of fibrous aneurysms were reported. Differences were found, with regard to the distribution of age and race, the clinical course, and the possible etiology.