Congenital left ventricular aneurysms and diverticula: clinical findings, diagnosis and course

Congenital aneurysms or diverticula of the left ventricle are rare findings that can be detected by both echocardiography and/or left ventricular angi ography. We investigated 16 adult patients presenting either with left vent ricular aneurysms (n = 8, mean age 33 +/- 12 years) or diverticula (n = 8, mean age 53 +/- 15 years). In 6 patients the first manifestation of the dis ease were ventricular arrhythmias, while in the remaining 10 patients the d iagnosis was established after echocardiographic examination or cardiac cat heterization in search of embolic events, valvular disease or atypical ches t pain. In all patients ischaemic heart disease, dilated or hypertrophic ca rdiomyopathy or arrhythmogenic right ventricular cardiomyopathy could be ru led out. Most of the aneurysms and diverticula were localized below the mit ral valve. Patients underwent surgery (n = 1), implantation of cardioverter -defibrillator ICD (n = 2), radiofrequency catheter ablation (n = 1) or dru g therapy with class III antiarrhythmics or beta-adrenergic blocking agents (n = 8). Four patients are receiving long-term anticoagulation. With this individually tailored therapy a favourable outcome can be expected in most cases, although during follow-up of 61 (9-121) months one patient died from left heart failure due to amiodarone-induced hyperthyroidism; there were n o cerebrovascular complications. Conclusion: Differential diagnosis of symptomatic ventricular tachyarrhythm ias or embolic events of unknown origin should include congenital ventricul ar aneurysms or diverticula.