Double-chambered left ventricle: a diagnosis made by multimodality imaging
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CASE IMAGE IN CARDIOVASCULAR ULTRASOUND
Double‑chambered left ventricle: a diagnosis made by multimodality imaging Dinesh K. Kalra1 · Christina Anderson1 · Sumit Sohal2 · Rupa Sanghani1 · Wojciech Mazur3 · Annabelle Santos Volgman1 Received: 21 February 2019 / Revised: 15 May 2019 / Accepted: 21 May 2019 © Japanese Society of Echocardiography 2019
A 30-year-old woman presented at 13 weeks gestation with palpitations. Exam, laboratories, electrocardiogram and Holter were normal. Echocardiogram (Fig. 1a, Video 1) showed double-chambered left ventricle (LV). Color and pulse-wave Doppler showed normal flow pattern at the mouth of the diverticulum without flow acceleration (systolic velocity 68 cm/s, diastolic velocity 55 cm/s). Blood entered the diverticulum in diastole and was ejected out of it in systole, just as occurs in the normal LV (Fig. 1b, c). Cardiac MRI (CMR) showed a large diverticulum in the mid-inferolateral LV (52 mm × 18 mm × 25 mm). There was no thrombus. Biventricular size, systolic function, wall motion, pericardium and valves were all normal (Fig. 1 e, f, Video 2). There was no evidence of noncompaction. Gadolinium contrast could not used due to pregnancy. To differentiate between fibrous versus muscular diverticulum, feature-tracking strain was done (Fig. 1g, Video 3). Systolic strain values were normal indicating that the diverticulum was composed of contractile, healthy myocardium. Fetal echocardiogram showed no abnormalities. She delivered a healthy baby vaginally at term and has had no further symptoms for over 1 year now.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12574-019-00429-w) contains supplementary material, which is available to authorized users.
Left ventricular diverticula are rare with a prevalence of 0.04% in adult patients [1]. Given that many patients are asymptomatic, the true prevalence may be higher. Doublechambered ventricle is more often seen in the right ventricle rather than the left, and is usually associated with other congenital defects such as septal defects, transposition of the great arteries, or tetralogy of Fallot [2]. However, doublechambered LV is usually an isolated defect and is benign as in our patient. Only rarely do complications occur such as thrombus formation and embolic phenomena, infective endocarditis, arrhythmias, rupture, herniation through the pericardium, and sudden cardiac death [1, 3]. These are more common in fibrous as opposed to muscular diverticula. In our patient, CMR was useful to rule any other associated abnormalities and strain was very helpful in characterizing the myocardium as normal. This allowed us to rule out an aneurysm or pseudoaneurysm, or fibrous tissue, all of which will have abnormal strain values. Thus, multimodality imaging can assist in making the proper diagnosis, ruling out other associated anomalies and in differentiating it from aneurysm or other masses [4, 5]. While cardiac CT has excellent spatial resolution to visualize these abnormalities, it is relat
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