Asymptomatic isolated congenital left ventricular muscular diverticulum in an adult: a case report

Congenital ventricular diverticulum is a very rare malformation in adults. We describe a 21-year-old male with a congenital muscular left ventricular diverticulum in the inferior wall. The lesion was suspected on two-dimensional transthoracic echocardiography; transesophageal echocardiography allowed clear detection of the diverticulum as well of mild mitral valve prolapse. The diagnosis was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac anomalies, the patient was asymptomatic, and surgery was not deemed necessary.     

Left ventricular thrombosis and arterial embolism in acute anterior myocardial infarction

Abstract. To study left ventricular thrombus (LVT) formation and arterial embolism (AE), 106 consecutive patients with a first acute anterior myocardial infarction (AAMI) underwent two-dimensional echocardiography before discharge. Repeated assessments for detection of AE were performed. Patients were non-randomly allocated to either no heparin, low-dose heparin or high-dose heparin. LVT was found in 25 (26.9%) of 93 patients with technically satisfactory echocardiograms. Left ventricular (LV) wall motion impairment (P = 0.0017) and treatment with either heparin or low-dose heparin (P = 0.0019) were independent predictors of LVT formation. AE, all strokes, occurred in 10 patients (9.4%) and was strongly associated with high age (P = 0.0013). In conclusion. LVT and AE are frequent complications to AAMI. LV wall motion impairment predisposes for LVT and low-dose heparin seems not to prevent these complications.     

A case of congenital left ventricular diverticulum in an adult patient

Congenital left ventricular diverticulum (CL.koVD) refers to a localized cystic protrusion of the ventricular wall that interacts with the heart cavities through a narrow channel and is a rare heart malformation. In recent years, many cases of this disease involving infants and children have been reported, while few cases involving adults have been described. The case of an adult with CLVD who underwent successful surgery was retrospectively evaluated. The echocardiography examination indicated that the apical myocardium of the left ventricle was thin and bulging outward and that the contractile movement was significantly reduced. During the surgery, it was observed that the left ventricle was enlarged, and a left ventricular diverticulum structure was observed on the left side of the apex. A bovine pericardial patch of the corresponding size was used to continuously suture and repair the internal orifice of the diverticulum. The postoperative pathology revealed that the resected sample was composed of full myocardial tissue. This report focused on the imaging characteristics of left ventricular diverticula to improve the understanding of CLVD. With its simple, economical, and noninvasive characteristics, echocardiography presents the best option for diagnosing a ventricular diverticulum.     

Left ventricular pseudoaneurysm complicating a ruptured isolated congenital diverticulum

We report a case of 41-year-old woman who presented with chest tightness and shortness of breath. Transthoracic echocardiogram (TTE) showed left ventricular (LV) pseudoaneurysm of the inferior wall with preserved LV systolic function. Coronary angiogram was normal. Surgical repair of the pseudoaneurysm with a pericardial patch was performed, and pathological results confirmed rupture of an isolated congenital LV diverticulum, as the most likely etiology.     

Left ventricular thrombosis and arterial embolism after thrombolysis in acute anterior myocardial infarction: predictors and effects of adjunctive antithrombotic therapy

The prevalence of left ventricular (LV) thrombosis and incidenceof arterial embolism after acute anterior myocardial infarction(AAMI) treated with streptokinase 1.5 x 10⁶ IU intravenouslywas studied in 136 patients enrolled consecutively in five cardiologicalcentres. Adjunctive antithrombotic therapy was administeredaccording to the routine of each centre. Thrombus formationwas studied by two-dimensional echocardiography, and eventsof arterial embolism recorded. LV thrombosis was found in 37 (27.2%) of the patients. In asubgroup of 53 patients receiving post-thrombolytic therapywith acetylsalicylic acid only, a thrombus developed in 14 (26.4%).The thrombus prevalence among patients given high-dose heparinwas significantly lower than among those receiving either low-doseheparin or no heparin (4/30 vs 33/106, P = 0.045). Logistic regression analysis suggested that severe LV wall motionabnormality (P & 0.001) and avoidance of treatment withhigh-dose heparin(P = 0.023) were independent predictors ofLV thrombus formation. Only one patient (0.7%) suffered arterial embolism (ischaemicstroke). In conclusion, LV thrombosis is frequent after thrombolytictherapy for AAMI, and impaired LV wall motion represents anindependent predisposing factor. Low-dose heparin and acetylsalicylicacid seem less effective for LV thrombus prophylaxis than high-doseheparin. The incidence of arterial embolism is low.     

Left ventricular diverticulum mimicking cardiac tumor

Left ventricular (LV) diverticulum represents a rare and frequently asymptomatic congenital anomaly, which is incidentally discovered during routine transthoracic echocardiography. We present a case of a 66‐year‐old female patient who was admitted to the cardiology department due to incidental finding of a tumor‐like mass associated with the posterior mitral leaflet. Preliminary echocardiographic evaluation revealed a solid structure, suspected of mitral annulus calcification or LV malignancy. However, cardiac contrast‐enhanced computed tomography confirmed the presence of LV diverticulum, partially filled with calcified thrombus. Conservative management was recommended. This case underscores the importance of multimodality imaging for differentiation of LV tumor‐like structures.     

Congenital left ventricular diverticulum: Multimodality imaging evaluation and literature review

Congenital ventricular diverticulum is a rare cardiac malformation. We present the case of a 57-year-old man who underwent cardiac catheterization for suspected unstable angina. No coronary artery disease was diagnosed and a left ventricular diverticulum was incidentally found. Coronary CT and cardiac MRI were performed in order to confirm the diagnosis of a muscular type diverticulum and to exclude a post-ischemic aneurysm.     

高血压病患者左心室向心性肥厚与颈动脉僵硬度的相关性研究

[摘 要] 目的 研究高血压患者颈动脉硬化与左心室向心性肥厚之间的相关性。方法 回顾性分析303例高血压患者作为研究对象，90例同龄健康自愿者作为对照组。患者进行超声心动图和颈动脉超声高分辨率回声跟踪检查。基于左心室质量指数(left ventricular mass index，LVMI)和相对壁厚(relative wall thickness，RWT)将高血压患者分成四个小组：正常几何构型(normal geometry，N， 57例), 向心性重构（concentric remodeling，CR, 48例)，向心性肥厚(concentric hypertrophy, CH, 62例)和偏心肥厚(eccentric hypertrophy，EH，35例)。基于β硬化度（β）、杨氏弹性模量(Young elastic modulus，Ep)、动脉动脉顺应性(arterial compliance，AC)、单点脉搏波速度(one-point pulse wave velocity，PWVβ)和波反射增强指数(wave reflection augmentation index，AI)对患者左心室内中膜复合体壁厚度(Intima-media thickness，IMT)和动脉硬化度进行评估。结果 单变量分析结果显示β-硬化度> 8.4、杨氏弹性模量Ep > 136 kPa、局部单点脉搏波速度-β> 7.1 m / s、增加指数AI > 21.9%、收缩压> 151 mm Hg、脉压 > 54、IMT > 0.56及糖尿病与向心性肥厚显著相关。然而，多变量分析结果显示只有增加指数AI（OR=3.64，p = 0.04），局部单点脉搏波速度-β> 7.1 m/s（OR=2.82，p = 0.013），收缩压（OR=3.11，p = 0036）及糖尿病（OR=3.73，p = 0.007）与患者向心性肥厚独立相关。结论 高血压患者向心性肥厚与颈动脉硬化及波反射增强指数显著相关，而与收缩压和糖尿病独立相关。     

全动脉化冠状动脉旁路移植术在左心功能不全患者中的应用

目的:评估2根动脉桥血管全动脉化冠状动脉(冠脉)旁路移植术在左心功能不全患者中应用的可行性和安全性。方法:前瞻性收集1994年11月~2002年8月用2根动脉桥血管进行全动脉化冠脉旁路移植术的179例左室射血分数(LVEF)<50%(正常≥70%)的冠脉多支病变临床病例进行研究。其中急性冠脉综合征3例,不稳定型心绞痛43例;LVEF<30)例;2次手术14例,3次手术3例。82%的患者应用含有左侧乳内动脉的Y型桥(其中右乳内动脉40.8%,桡动脉33.5%,其他7.8%)。结果:左心功能不全组围术期死亡率2·2%,心肌梗死1.7%,脑血管意外0.6%,胸骨感染3.3%,呼吸衰竭7.8%,与左心功能正常组相比较差异无统计学意义。结论:左心功能不全患者可以安全地用2根动脉桥血管进行全动脉化冠脉旁路移植术。桡动脉长于右乳内动脉,即使左心功能不全(左室扩大)的情况下也足以完成全动脉化冠脉旁路移植术。     

Isolated large true contractile left ventricular diverticulum mimicking ischemia in an adult patient: a case report

Congenital diverticulum of the ventricle is a rare cardiac abnormality that is characterized by local embryologic development failure of the ventricular muscle. It can be found as an isolated form or associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to heart failure, arrhythmia, or chest pain, although frequently the course is asymptomatic. We present a patient who was referred to our clinic with chest pain due to isolated left ventricular diverticulum mimicking myocardial ischemia.     

Cell therapy in patients with left ventricular dysfunction due to myocardial infarction

Objectives: The purpose of this study was to determine the impact of autologous transplantation of mononuclear bone marrow cells on myocardial function in patients with left ventricular (LV) dysfunction due to an acute myocardial infarction. Methods: The randomized study included 82 patients with a first acute myocardial infarction treated with a stent implantation. This presentation is a subanalysis of 47 patients with left ventricular dysfunction–EF (ejection fraction) ≤ 40%. Group H patients (n = 17) received higher number (100,000,000) of cells; Group L patients (n = 13) received lower number (10,000,000) of cells. The patients of control Group C (n = 17) were not treated with cells. The Doppler tissue imaging and single photon emission computed tomography were performed before cell transplantation and 3 months later. Results: At 3 months of follow‐up, the baseline EF of 35%, 36%, 35% in Groups H, L, and C increased by 6% (P < 0.01 vs. baseline), 5% (P < 0.01 vs. baseline), and 4% (P = NS vs. baseline), respectively, as assessed by single photon emission computed tomography (P = NS between groups). The baseline number of akinetic segments of 6.9, 7.0, and 6.2 in H, L, and C groups decreased by 1.7 (P < 0.01 vs. baseline), 1.5 (P < 0.01 vs. baseline), and 0.7 (P = NS vs. baseline, P = NS between groups), respectively, as demonstrated by echocardiography. Conclusion: In our study, the statistically important effect of transplantation of mononuclear bone marrow cells on myocardial function was not found. Only an insignificant trend toward the improvement of global LV EF fraction was found at 3‐month follow‐up.     

Multimodality detection of multiple left ventricular diverticula: A case report and brief review of the literature

Left ventricular diverticula (LVD) are rare congenital anomalies usually detected incidentally in the adult population. Most commonly, they are found as a single left ventricular diverticulum in association with other congenital abnormalities but multiple LVD are exceedingly rare. We are describing a patient who was found to have multiple LVD on multimodality imaging studies. He had presented with a sudden cardiac arrest attributed to a combination of alcohol intoxication and QT interval prolongation from hypokalemia and antidepressant medications. The patient was managed conservatively and discharged with an implantable loop recorder for detecting any occult arrhythmias.     

Right ventricular responses to massive and submassive pulmonary embolism

It is critically important to quickly recognize and treat acute pulmonary embolism (PE). Submassive and massive PEs are associated with right ventricular (RV) dysfunction and may culminate in RV failure, cardiac arrest, and death. A rapid and coordinated diagnostic and management approach can maximize success and save lives.     

中老年高血压伴左室肥厚患者周围动脉硬化特点及相关性分析

目的 探讨中老年高血压伴左室肥厚(LVH)患者周围动脉硬化特点及二者的相关性. 方法 149例中老年高血压患者入选本研究,其中高血压伴LVH 67例为LVH组,高血压非左室肥厚(NLVH) 82例为NLVH组,并选择同期健康体检者48例作为正常对照组,应用动态血压检查动态动脉硬化指数(AASI)对全身的动脉硬化程度进行评估;同时应用超声评价颈动脉粥样硬化程度,然后进行组间对比及相关性分析. 结果 LVH组AASI最高,NLVH组次之,均明显高于对照组(P ＜0.01);EH患者与正常组比较,颈动脉内-中膜厚度(CCA-IMT)、颈动脉超声阳性检出率增加,LVH组显著高于NLVH组. 结论 EH患者在出现LVH之前,外周动脉就发生一系列结构和功能上的改变,LVH患者动脉硬化更明显,因此动脉硬化在LVH发生发展中起着重要的作用.     

Isolated muscular ventricular diverticulum assessment using multi-parameter echocardiographic imaging: Case reports

Ventricular diverticulum (VDi) is a rare and often asymptomatic congenital cardiac malformation detected incidentally as an outpouching on routine imaging examination, of which the muscular type has been less reported. Here, two patients were incidentally found to have outpouchings of the ventricle during routine transthoracic echocardiography. After a series of multi-parameter echocardiography examination, including two-dimensional (2D), three-dimensional (3D) photo-realistic rendering, blood speckle tracking (BST), and contrast enhancement, to provide morphological structure, spatial relationship, and blood flow information, both cases were finally diagnosed with muscular VDi. These cases highlight the advantages of using multi-parameter echocardiography for the comprehensive assessment of muscular VDi.     

Association between fasting plasma glucose and left ventricular mass and left ventricular hypertrophy over 4 years in a healthy population aged 60 and older

OBJECTIVES: To test the association between fasting glucose level and left ventricular mass (LVM) and left ventricular hypertrophy (LVH) in people aged 60 and older. DESIGN: Population-based prospective study with 4-year follow-up. SETTING: Department of Internal Medicine and Family Medicine, Kaohsiung Medical University (KMU), Chung-Ho Memorial Hospital, and Graduate Institute of Medicine and Public Health, KMU. PARTICIPANTS: Of 1,500 people screened, 105 without symptoms or signs of diabetes mellitus, hypertension, or cardiovascular disease were recruited from senior activity centers in Kaohsiung city. MEASUREMENTS: All received two-dimensional echocardiography and fasting glucose examination at baseline and at 2- and 4-year follow-up. LVH was defined as a LVM index (LVMI) greater than 122.4 g/m(2) or 51 g/m(2.7). RESULTS: Age ranged from 60 to 81 (mean 71.7+/-3.9). Baseline glucose ranged from 83 to 118 mg/dL (mean 99.7+/-7.9 mg/dL). LVMI was significantly higher at the 4-year follow-up (97.5+/-24.9 vs 104.5+/-27.5 g/m(2) and 44.2+/-12.1 vs 47.2+/-13.4 g/m(2.7), both P<.01), as was the occurrence of LVH (16% vs 32% and 25% vs 39%, both P<.01). Baseline glucose correlates with 4-year change in LVMI (both P<.02). In the fourth year, baseline glucose was a significant predictor of LVMI (both P<.01) and LVH (P=.03 in g/m(2) definition) using logistic regression analysis. CONCLUSION: Because fasting glucose is an independent predictor for greater LVM and for development of LVH, it should be considered in assessment of cardiac disease and LVM in healthy older people without diabetes mellitus.     

Role of left ventricular geometry in the alteration of initial QRS vectors due to concentric ventricular hypertrophy

The relation between serial magnitudes of instantaneous spatial vectors, obtained throughout ventricular depolarization, and echocardiographically estimated left ventricular (LV) mass was investigated in 64 patients with congenital aortic stenosis and in 16 patients with coarctation of the aorta. While the correlation was positive between LV mass and vector magnitudes at 50 and 60 ms after QRS onset (r = .530 and .557, P < .01), it was found to be negative with regard to the magnitude of the initial 10 and 20 ms vectors (r = −.285 and −.355, P<.01). Computer simulation of activation propagation in different models of LV enlargement has shown that the decrease of the spatial magnitude of initial vectors, as well as a marked decrease of the area of the anterior portion of the horizontal plane QRS loop and of the Q amplitude of the orthogonal z lead, are characteristic of concentric LV hypertrophy with decreased diastolic volume and were not observed with unchanged or dilated chamber size. Repeated assessment of the magnitude of initial QRS vectors may indicate changes of LV remodeling in patients with LV pressure overload.     

Multiple left ventricular diverticuli in an asymptomatic adult: case report and review of the literature.

Left ventricular (LV) diverticulum is a rare congenital abnormality for which the etiology, management, and natural history are very poorly understood. Although most often observed as a single diverticulum, we report a case of multiple LV diverticuli in an asymptomatic adult referred for coronary evaluation due to an abnormal electrocardiogram. LV diverticuli are often associated with other congenital malformations, but can also be found in isolation. Cardiac magnetic resonance imaging provides enhanced ability to determine size, location, and morphological characteristics, which may improve lesion assessment and management. A review of the condition and reported complications is discussed.