Left Ventricular Diverticulum of the Interventricular Septum

Cardiac ventricles; Echocardiography

In this study, we report a case of a healthy, 25‑year‑old male patient with presyncope during a football match divergent blood pressure, and a grade 3/6 aortic diastolic murmur. The echocardiogram showed a rounded structure in the basal area of the interventricular septum adjacent to the aortic valve, which causes inadequate commissural support, communicating with the left ventricle (LV). There was moderate secondary aortic insufficiency and dilated LV with preserved contractility. MRI revealed myocardial density in the structure without delayed enhancement. After follow-up, the LV increased further in size and syncope on exertion. The patient underwent surgery and the anatomic pathologist diagnosed left ventricular diverticulum. The diverticulum, a congenital protrusion in the myocardial wall of the LV, differs from an aneurysm by its close connection to the chamber and presence of myocardial fibers in the composition of the wall¹. It most often affects the LV or right ventricular apex and is rare in the septum.

Figure 1
A) Transthoracic echocardiogram, parasternal longitudinal view, showing the diverticulum in the interventricular septum (arrow) adjacent to the right coronary cusp of aortic valve; B) apical five-chamber view showing the aortic regurgitant jet and apparent structural communication with the LV cavity (Doppler flow); C) Cardiac MRI, axial view in dark blood sequence, and T1-weighted image, confirms the continuity solution (arrow); D) short basal axis view sequence of cine-MRI (perfusion) shows isointense structure (muscular) and hypointense content.

• Sources of Funding
  There were no external funding sources for this study.
• Study Association
  This study is not associated with any thesis or dissertation work.

Reference

• ¹
  Barberato MF, Barberato SH, Binotto CN, Cavalcanti MJ, Passos AP, Miyague NI. Prenatal diagnosis of left ventricular aneurysm and diverticulum. Arq Bras Cardiol. 2009;93(2):e36-8.

Publication Dates

• Publication in this collection
  Jan 2015

History

• Received
  05 July 2014
• Reviewed
  28 Aug 2014
• Accepted
  04 Sept 2014