scholarly journals Congenital Ventricular Diverticulum or Aneurysm: A Difficult Diagnosis to Make

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Lloyd Halpern ◽  
Carl Garabedian ◽  
Neil K. Worrall
Keyword(s):  
Left Ventricle ◽  
Congenital Anomalies ◽  
Treatment Plan ◽  
Left Ventricular ◽  
Free Wall ◽  
Surgical Team ◽  
Intraoperative Echocardiography ◽  
Difficult Diagnosis ◽  
Ventricular Diverticulum

A pouch protruding from the free wall of the left ventricle may be either a congenital ventricular diverticulum (CVD) or aneurysm (CVA). Being aware of these rare congenital anomalies is critical in making the diagnosis. Differentiating the two is important for treatment decisions. We describe a patient with dextrocardia, Tetralogy of Fallot, and a congenital left ventricular apical diverticulum diagnosed following the induction of anesthesia. CVD and CVA may present in the antenatal period through late adulthood with differing morphology, location, and symptoms. Echocardiography is paramount in the diagnosis and characterization of these lesions. If this anomaly is encountered after the induction of anesthesia or during intraoperative echocardiography, the cardiothoracic anesthesiologist should make the surgical team aware so it can be further characterized and a treatment plan made prior to incision.

Ventricular systolic interdependence: volume elastance model in isolated canine hearts

1987 ◽  
Vol 253 (6) ◽  
pp. H1381-H1390 ◽  
Author(s):  
W. L. Maughan ◽  
K. Sunagawa ◽  
K. Sagawa
Keyword(s):  
Left Ventricle ◽  
Right Ventricle ◽  
Cross Talk ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Systolic Volume ◽  
The Right

To analyze the interaction between the right and left ventricle, we developed a model that consists of three functional elastic compartments (left ventricular free wall, septal, and right ventricular free wall compartments). Using 10 isolated blood-perfused canine hearts, we determined the end-systolic volume elastance of each of these three compartments. The functional septum was by far stiffer for either direction [47.2 +/- 7.2 (SE) mmHg/ml when pushed from left ventricle and 44.6 +/- 6.8 when pushed from right ventricle] than ventricular free walls [6.8 +/- 0.9 mmHg/ml for left ventricle and 2.9 +/- 0.2 for right ventricle]. The model prediction that right-to-left ventricular interaction (GRL) would be about twice as large as left-to-right interaction (GLR) was tested by direct measurement of changes in isovolumic peak pressure in one ventricle while the systolic pressure of the contralateral ventricle was varied. GRL thus measured was about twice GLR (0.146 +/- 0.003 vs. 0.08 +/- 0.001). In a separate protocol the end-systolic pressure-volume relationship (ESPVR) of each ventricle was measured while the contralateral ventricle was alternatively empty and while systolic pressure was maintained at a fixed value. The cross-talk gain was derived by dividing the amount of upward shift of the ESPVR by the systolic pressure difference in the other ventricle. Again GRL measured about twice GLR (0.126 +/- 0.002 vs. 0.065 +/- 0.008). There was no statistical difference between the gains determined by each of the three methods (predicted from the compartment elastances, measured directly, or calculated from shifts in the ESPVR). We conclude that systolic cross-talk gain was twice as large from right to left as from left to right and that the three-compartment volume elastance model is a powerful concept in interpreting ventricular cross talk.

scholarly journals Successful Surgical Treatment of Postinfarction Rupture of Left Ventricular Myocardium

2020 ◽  
Vol 9 (1) ◽  
pp. 140-147
Author(s):  
M. K. Mazanov ◽  
N. I. Kharitonova ◽  
A. A. Baranov ◽  
S. Yu. Kambarov ◽  
N. M. Bikbova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Surgical Intervention ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Free Wall ◽  
Fatal Complication ◽  
Widespread Availability ◽  
Complications Of Myocardial Infarction

ABSTRACT. The rupture of the left ventricle free wall is one of the most dangerous complications of myocardial infarction. Due to the widespread availability of echocardiography method, the detection of this fatal complication and the number of lives saved after surgery grew. The survival of patients depends on early diagnosis, stabilization of the patient’s condition, promptness and tactics of surgical intervention. We report a case of successful closure of a rupture of the left ventricle free wall on the 15th day after myocardial infarction.

scholarly journals P1333 The importance of multimodality imaging in the characterization of a congenital myocardial diverticulum

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
G Ramirez-Escudero Ugalde ◽  
A M R Arantza Manzanal Rey ◽  
N G I Nora Garcia Ibarrondo ◽  
M C P Mireia Codina Prat ◽  
L R G Lara Ruiz Gomez ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Tissue Characterization ◽  
Multimodality Imaging ◽  
Interventricular Septum ◽  
Fibrous Tissue ◽  
Scar Tissue ◽  
Left Ventricular ◽  
Ventricular Diverticulum ◽  
Asymptomatic Patients

Abstract Congenital ventricular diverticulum is a rare cardiac malformation, usually detected on echocardiographic examinations in asymptomatic patients. However, they can also cause embolisms, arrhythmias and sudden death due to ventricular rupture. Multimodality imaging can help in the characterization of its morphology and in the differential diagnosis. We report a case of an 83-year-old woman, pacemaker carrier due to complete atrioventricular block, who consulted for paroxysmal episodes of palpitations, being diagnosed of atrial fibrillation. A transthoracic echocardiogram was performed, observing an appendix at basal septal level with contractility of its wall and with doppler-colour inside, suggestive of myocardial diverticulum. Echocardiographic contrast was injected for better delimitation and characterization of the cavity. MRI was after performed for better characterization of this structure, confirming the presence of an accessory chamber with muscular wall and normal contractility at the level of the basal interventricular septum, without pathological enhancements. We reviewed an angioCT performed for other reasons some years ago, confirming the presence of the same structure, which went unnoticed in that study. The patient followed controls and remained asymptomatic, without evolutionary echocardiographic changes, so that a conservative attitude was maintained. Congenital ventricular diverticulum is formed by an appendix of the entire left ventricular (LV) wall. It can be differentiated into two types: muscular (more frequent, not prone to rupture and associated with other congenital malformations) or fibrous (frequently localized at the base of the heart or in subvalvular areas). Differential diagnosis may include true LV aneurysms (abnormal LV contour with systolic dyskinesia and involving thinned fibrous tissue) and LV pseudoaneurysms (acute contained rupture of the ventricle wall, often after myocardial infarction, also akinetic or dyskinetic). Congenital cardiac diverticulum is characterized by a rapid contrast filling and a narrow neck. MRI provide tissue characterization and is an important tool that helps in the differential diagnosis. In cardiac diverticulums, a thinned but contractile wall is present, without pathological delayed enhancements. In true aneurysms, the wall shows delayed enhancement (scar tissue). Pseudoaneurysms are only composed by pericardium, and the border of the aneurysms show enhancement indicating peri-aneurysmal infarcted area. Left ventricular catheterization can also be useful assessing the morphology and dynamics of the left ventricular chamber. In small, muscular and asymptomatic diverticulums, conservative treatment with follow-up is often recommended. When symptoms appear, medical or surgical treatment should be proposed. Abstract P1333 Figure. Congenital myocardial diverticulum

Mechanical complications of myocardial infarction

2018 ◽  
Author(s):  
José López-Sendón ◽  
Esteban López de Sá
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
Free Wall ◽  
Papillary Muscle Rupture ◽  
Mechanical Complications ◽  
Muscle Rupture

Mechanical complications after an acute infarction involve different forms of heart rupture, including free wall rupture, interventricular septal rupture, and papillary muscle rupture. Its incidence decreased dramatically with the widespread use of reperfusion therapies occurring in <1% of ST-elevation myocardial infarction patients, and mortality is very high if not properly diagnosed, as surgery is the only effective treatment (Ibanez et al, 2017). Echocardiography is the most important tool for diagnosis that should be suspected in patients with hypotension, heart failure, or recurrent chest pain. Awareness and well-established protocols are crucial for an early diagnosis. Modern imaging techniques permit a more reliable and direct identification of left ventricular free wall rupture, which is almost impossible to identify with conventional echocardiography. Mitral regurgitation, secondary to papillary muscle ischaemia or necrosis or left ventricular dilatation and remodelling, without papillary muscle rupture, is frequent after myocardial infarction and is considered as an independent risk factor for outcomes. Revascularization to control ischaemia and surgical repair should be considered in all patients with severe or symptomatic mitral regurgitation in the absence of severe left ventricular dysfunction. Other mechanical complications include true aneurysms and thrombus formation in the left ventricle. Again, these complications have decreased with the use of early reperfusion therapies and, for thrombus formation, with aggressive antithrombotic treatment. In a single large randomized trial (STICH), surgical remodelling of the left ventricle failed to demonstrate a significant improvement in outcomes, although it still may be an option in selected patients.

Subacute Left Ventricular Free-Wall and Double Cardiac Rupture: Clinical Features and Surgical Considerations of a Surgically Salvageable Condition

1994 ◽  
Vol 2 (2) ◽  
pp. 78-82
Author(s):  
Harinder Singh Bedi ◽  
Vijay Kumar Sharma ◽  
Vijay Kohli ◽  
Anil Mishra ◽  
Ashok Jayant ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricle ◽  
Cerebrovascular Accident ◽  
Surgical Intervention ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Cardiac Rupture ◽  
Free Wall ◽  
Review Of The Literature ◽  
Left Ventricular Free Wall

Subacute cardiac rupture after myocardial infarction carries a high mortality. This article describes 4 cases—3 with rupture of the left ventricle and 1 with a combined rupture of the left ventricle and interventricular septum (double rupture). All patients were successfully operated; however, the patient with the double rupture died of a massive cerebrovascular accident on the 8th postoperative day. The importance of early diagnosis and prompt surgical intervention is discussed, along with a review of the literature.

Congenital Giant Diverticulum of the Left Ventricle in an Adult

2005 ◽  
Vol 13 (1) ◽  
pp. 79-81 ◽  
Author(s):  
Sai S Oruganti ◽  
Dharma R Ayapati ◽  
Milton A James ◽  
Jagan MR Jinna ◽  
Seshagiri R Damera ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Left Ventricular ◽  
Resonance Imaging ◽  
Ventricular Diverticulum ◽  
Giant Diverticulum ◽  
Left Ventricular Diverticulum ◽  
History Of ◽  
Congenital Diverticulum

Congenital diverticulum of the left ventricle is a rare anomaly. Echocardiography, cardiac catheterization, and magnetic resonance imaging of the heart diagnosed a giant left ventricular diverticulum in a 20-year-old male with a history of dyspnea and palpitations. He underwent successful surgical correction of the left ventricular diverticulum.

A prosthetic myocardium for repair of localized defects of the left ventricle: Concept and hemodynamic feasibility

1980 ◽  
Vol 3 (3) ◽  
pp. 173-179
Author(s):  
A. Kantrowitz ◽  
T. Igari ◽  
I. Hayashi ◽  
P.S. Freed
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Experimental Investigation ◽  
Left Ventricle ◽  
Treatment Plan ◽  
Surgical Excision ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Surgical Approaches ◽  
Left Ventricular Myocardium

As an approach to the treatment of patients with large but circumscribed akinetic or dyskinetic regions in the left ventricular myocardium as sequelae of acute myocardial infarction, excision of the defect and implantation of a mechanical functional equivalent of myocardium is suggested. Experimental investigation of this technique is described. Hemodynamic data from a series of dog experiments indicate that activation of the prosthetic myocardium after excision of the left ventricle is followed by improvement in various hemodynamic parametres of interest Although substantial experimental work must be completed and difficult bioengineering problems solved, preliminary results have encouraged us to continue our investigations of the prosthetic myocardium. An imposing array of treatment methods is now available to the clinician who must deal with the sequelae of acute myocardial infarction. Selecting from pharmacologic, electrophysiologic, and surgical approaches the physician can in many instances design a treatment plan precisely tailored to the clinical problem. Large left ventricular aneurysms and their functional equivalents of ventricular dyskinesis or hypokinesis continue, however, to represent a class of problems in which established techniques have been less then satisfactory. Surgical excision with closure of the defect is regarded as effective for small aneurysms, but such procedures may so compromise cardiac output in patients with large ones as to be unacceptable. Unfortunately, it is just the latter group in which medical palliation is least likely to be effective in managing congestive failure, angina, and other pathophysiologic manifestations. A relatively unsual approach derived from in-series techniques of mechanical assistance to the failing circulation (1) offers the theoretical possibility of a treatment tailored to the problem of a large ventricular aneurysm. Experimental investigation of this technique in the Surgical Research Laboratory at the Sinai Hospital of Detroit has progressed to the point that a report of our experiences to date may be of interest.

scholarly journals Correlation between the periodontal treatment and ecocardiographic changes in adult dogs

Interação ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 43-57
Author(s):  
Daniel Paulino Júnior ◽  
Marina Queiroz Derruci ◽  
Leandro Zuccolotto Crivelenti ◽  
Brenda Faria Santos Gomes Parreira ◽  
Fernanda Gosuen Gonçalves Dias
Keyword(s):  
Left Ventricle ◽  
Periodontal Disease ◽  
Dental Treatment ◽  
Oral Treatment ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Periodontal Treatment ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Left Ventricular Free Wall

Periodontal disease is commonly diagnosed in dogs and has been associated with systemic lesions in several organs, however, studies correlating this oral condition with heart disease in the canine species are still scarce in the scientific literature. Thus, the objective of the present study was to evaluate such correlation in adult dogs, through serial echocardiographic exams and, nonetheless, to analyze the influence of dental treatment on cardiac function. For this, 60 dogs were used, distributed in two groups, the control (CG, n = 30: presence of periodontal disease, not submitted to oral treatment) and the treated (GT, n = 30: presence of periodontal disease and submitted to oral treatment). The animals of the CG were paired with those of the GT in terms of race, weight, age and degree of periodontal disease. Baseline echocardiographic examinations (D0) of the CG were performed and after 30 days (D30). In GT, examinations were also performed at D0 and D30, however, they were submitted to periodontal treatment after baseline measurements. The echocardiographic exams were performed at the Veterinary Cardiology Laboratory of the Veterinary Hospital of the University of Franca, to record and analyze the interventricular septum in diastole (SIVd), interventricular septum in systole (SIVs), diameter of the left ventricle in diastole (DVEd), left ventricular diameter in systole (EVDs), left ventricular free wall in diastole (PVEd) left ventricular free wall in systole (PVEs) shortening fraction of left ventricle (FS), final diastolic volume (VDF), final stroke volume (VSF), ejection fraction (EF), maximum pulmonary artery pressure gradient (max. GP AP) and left atrial and aortic artery diameter ratio (EA-AO). The results of the CG were statistically compared with those of the GT by means of simple analysis of variance (ANOVA). The data obtained regarding the SIVs, DVEd and PVEs parameters of the GT dogs at D30 showed a statistically significant decrease (p<0.05) when compared to the D30 of the CG. Thus, given the established methodology and the results found, it is possible to infer that periodontal treatment may benefit some cardiac parameters of adult dogs, improving their quality of life and survival.

scholarly journals Contribution of myocardium overlying the anterolateral papillary muscle to left ventricular deformation

2012 ◽  
Vol 302 (1) ◽  
pp. H180-H187 ◽  
Author(s):  
Akinobu Itoh ◽  
Elizabeth H. Stephens ◽  
Daniel B. Ennis ◽  
Carl-Johan Carlhall ◽  
Wolfgang Bothe ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Papillary Muscle ◽  
Regional Differences ◽  
Left Ventricular ◽  
Free Wall ◽  
Regional Heterogeneity ◽  
Left Ventricular Deformation ◽  
Principal Strains

Previous studies of transmural left ventricular (LV) strains suggested that the myocardium overlying the papillary muscle displays decreased deformation relative to the anterior LV free wall or significant regional heterogeneity. These comparisons, however, were made using different hearts. We sought to extend these studies by examining three equatorial LV regions in the same heart during the same heartbeat. Therefore, deformation was analyzed from transmural beadsets placed in the equatorial LV myocardium overlying the anterolateral papillary muscle (PAP), as well as adjacent equatorial LV regions located more anteriorly (ANT) and laterally (LAT). We found that the magnitudes of LAT normal longitudinal and radial strains, as well as major principal strains, were less than ANT, while those of PAP were intermediate. Subepicardial and midwall myofiber angles of LAT, PAP, and ANT were not significantly different, but PAP subendocardial myofiber angles were significantly higher (more longitudinal as opposed to circumferential orientation). Subepicardial and midwall myofiber strains of ANT, PAP, and LAT were not significantly different, but PAP subendocardial myofiber strains were less. Transmural gradients in circumferential and radial normal strains, and major principal strains, were observed in each region. The two main findings of this study were as follows: 1) PAP strains are largely consistent with adjacent LV equatorial free wall regions, and 2) there is a gradient of strains across the anterolateral equatorial left ventricle despite similarities in myofiber angles and strains. These findings point to graduated equatorial LV heterogeneity and suggest that regional differences in myofiber coupling may constitute the basis for such heterogeneity.

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