Prenatal diagnosis of left ventricular aneurysm: a report of three cases and a review

We report three cases of left ventricular aneurysm diagnosed prenatally and followed by fetal Doppler echocardiography. A review of the literature rev eals a paucity of information about this rare cardiac malformation. Most of the described cases (6 out of 9) have remained asymptomatic during pregnan cy and after birth. Our cases, in contrast, and three others in the literat ure, had an ominous prognosis presenting cardiac failure initially or durin g follow UP and showing a dynamic evolution of the aneurysm. Cross-sectiona l echocardiography provides the diagnosis, revealing the thin-walled aneury sm, usually apical, to be connected by a broad neck to the left ventricle. Color and pulsed Doppler shows low velocity and to-and-fro flow in the aneu rysm. Sequential fetal Doppler echocardiography detects the potential growt h of the aneurysm relative to ventricular site, revealing any compromise of cardiac performance by a decreased mitral opening, reversed atrial shuntin g, a hypokinetic infero-posterior left ventricular wall, and a poor systoli c thickening of the wall of the aneurysm. Compromise of cardiac function, a nd deleterious impact on development of the lungs during fetal life, may de pend on the early onset, growth and location of the aneurysm,which may occu py most of the fetal chest. We discuss issues of prenatal diagnosis, sequen tial surveillance of the natural history,and factors of prognosis as well a s myocardial histological data from one of our cases.