Top

Published in:

01-02-2020 | Echocardiography | Original Article

Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature

Published in: Pediatric Cardiology | Issue 2/2020

Abstract

Congenital ventricular outpouchings (CVOs) are rare congenital heart defects with limited data regarding prognosis and outcomes. We aimed to describe the characteristics, outcomes and factors associated with morbidity and mortality of prenatally diagnosed CVOs using our institutional experience and a review of published cases. A total of 86 cases of prenatally diagnosed CVOs were identified, including 3 from our institution and 83 cases identified from a review of the literature. Fetal and postnatal outcomes were analyzed for each case. Pericardial effusions (44%) and ventricular dysfunction (17%) were the most common associated findings. Excluding cases that resulted in pregnancy termination, mortality was 17%, with the majority (11/13) occurring in the prenatal period. Factors associated with mortality included an outpouching located on the left ventricle, a diagnosis of hydrops fetalis, the presence of a pericardial effusion, and an earlier gestational age at diagnosis. Of those that survived to delivery, 57% remained asymptomatic without the need for intervention, and the outpouching regressed or resolved in an additional 15%. Prenatally diagnosed congenital ventricular outpouchings are a dynamic form of congenital heart disease with a high fetal mortality rate. The outcomes associated with the outpouchings appear to be the most variable in the prenatal period and the first year after birth. Serial prenatal and postnatal evaluations should be performed to evaluate for a change in the characteristics of the outpouching.

Available only for authorised users

Goncalves L, Sims J, Philippe J (1992) Aneurysm, left ventricle. TheFetus.net. https://sonoworld.com/fetus/page.aspx?id=33. Accessed 17 Dec 1992

Williams J, Collardey K, Treadwell M, Owens S (2009) Prenatally diagnosed right ventricular outpouchings: a case series and review of the literature. Pediatr Cardiol 30(6):840–845CrossRefPubMed

Prefumo F, Bhide A, Thilaganathan B, Carvalho J (2005) Fetal congenital cardiac diverticulum with pericardial effusion: two cases with different presentations in the first trimester of pregnancy. Ultrasound Obstet Gynecol. 25(4):405–408CrossRefPubMed

Marijon E, Ou P, Fermont L, Concordet S, Le Bidois J, Sidi D, Bonnet D (2006) Diagnosis and outcome in congenital ventricular diverticulum and aneurysm. J Thorac Cardiovasc Surg 131(2):433–437CrossRefPubMed

Ohlow M, Bruneli M, Lauer B (2014) Characteristics and outcome of primary congenital left ventricular aneurysm and diverticulum: analysis of cases from the literature. Prenat Diagn 34(9):893–899CrossRefPubMed

Awad S, Patel A, Polimenakos A, Braun R, Abdulla R (2009) Left ventricular accessory chamber: a case report and review of the literature. Pediatr Cardiol 30(7):1022–1025CrossRefPubMed

Evans W, Madrid A, Castillo W, Rollins R, Berthoty D, Starnes V, Wiencek R, Ciccolo M, Acherman R (2009) All cardiac right ventricular outpouches are not created equal. Pediatr Cardiol 30(7):954–957CrossRefPubMed

Perlitz Y, Mukary M, Lorber A, Ben-Ami M (2009) Prenatal diagnosis of fetal cardiac right ventricular diverticulum disappearing at three months of age: a case report and literature review. Fetal Diagn Ther 25(1):44–46CrossRefPubMed

Wax J, Moran A, Pinette MG, Reyes A, Cartin A, Blackstone J (2007) Prenatal sonographic diagnosis of fetal right ventricular diverticulum. J Ultrasound Med 26(2):267–270CrossRefPubMed

10.

Malakan Rad E, Awad S, Hijazi Z (2014) Congenital left ventricular outpouchings: a systematic review of 839 cases and introduction of a novel classification after two centuries. Congenit Heart Dis 9(6):498–511CrossRefPubMed

11.

McAuliffe F, Hornberger L, Johnson J, Chitayat D, Ryan G (2005) Cardiac diverticulum with pericardial effusion: report of two new cases treated by in-utero pericardiocentesis and a review of the literature. Ultrasound Obstet Gynecol 25(4):401–404CrossRefPubMed

12.

Abi-Nader K, David A, Yates R, Pandya P (2009) Successful outcome after prenatal treatment of a cardiac diverticulum with massive pericardial effusion. Fetal Diagn Ther. 25(1):148–152CrossRefPubMed

13.

Barberato M, Barberato S, Binotto C, Cavalcanti M, Passos A, Miyague N (2009) Prenatal diagnosis of left ventricular aneurysm and diverticulum. Arg Bras Cardiol 93(2):e36–38CrossRef

14.

Carrard C, Massardier J, Pangaud N, Champion F (2010) Fetal right ventricular diverticulum with pericardial effusion: report of a new case treated by in utero pericardiocentesis. Pediatr Cardiol 31(6):891–893CrossRefPubMed

15.

Demir F, Ozbarlas N, Gocen U, Buyukkurt S (2015) Prenatal diagnosis of giant left ventricular diverticulum: case report. Echocardiography 32(2):395–397CrossRefPubMed

16.

Nam K, Kwon J, Son G, Cho N, Park Y, Kim Y (2010) Prenatally diagnosed left ventricular diverticulum with thoracoabdominal wall defect: a case and review of the literature. J Perinatol 30(11):760–762CrossRefPubMed

17.

Grethel E, Hornberger L, Farmer D (2007) Prenatal and postnatal management of a patient with pentalogy of Cantrell and left ventricular aneurysm: a case report and literature review. Fetal Diagn Ther 22(4):269–273CrossRefPubMed

18.

Matias A, Fredouille C, Nesmann C, Azancot A (1999) Prenatal diagnosis of left ventricular aneurysm: a report of three cases and a review. Cardiol Young 9(2):175–184CrossRefPubMed

19.

McElhinney D, Silverman N (1999) Left ventricular aneurysm in the fetus: a diagnosis with a mixed prognosis. Cardiol Young 9(2):123–126CrossRefPubMed

20.

Bernasconi A, Delezoide A, Menez F, Vuillard E, Oury J, Azancot A (2004) Prenatal rupture of a left ventricular diverticulum: a case report and review of the literature. Prenat Diagn 24(7):504–507CrossRefPubMed

21.

Oloron P, Ibarra C, Galdeano Miranda J (2011) Right ventricular outpouching associated with a ventricular septal defect: case report. Pediatr Cardiol 32(8):1269–1270CrossRefPubMed

22.

Del Rio M, Martinez J, Bennasar M, Palacio M, Figueras F, Puerto B, Mortera C, Cararach V (2005) Prenatal diagnosis of a right ventricular diverticulum complicated by pericardial effusion in the first trimester. Ultrasound Obstet Gynecol 25(4):409–411CrossRefPubMed

23.

Jacobson R, Perez A, Meyer R, Miodovnik M, Siddigi T (1991) Prenatal diagnosis of fetal left ventricular aneurysm: a case report and review. Obstet Gynecol 78(3 Pt 2):525–528PubMed

24.

Sharma J, Oforl-Amando G, Marboe C, Quaegebeur J (2002) Congenital left ventricular aneurysm with pericardial effusion: prenatal diagnosis, surgical management and follow-up. Pediatr Cardiol 23(4):458–461CrossRefPubMed

25.

Seo D, Won H, Ko J, Jhang W (2011) Modified damus-kaye-stansel/dor procedure for a newborn with severe left ventricular aneurysm. Korean Circ J 41(8):494–496CrossRefPubMedPubMedCentral

26.

Hirose A, Maeno Y, Suda K, Fusazaki N, Kado H, Matsuishi T (2013) Serial hemodynamic assessment using Doppler echocardiography in a fetus with left ventricular aneurysm presented as fetal hydrops. J Perinatol 33(6):486–489CrossRefPubMed

27.

Davidson A, Witeman V, Gaynor J (2006) Images in cardiovascular medicine fetal cardiac diverticulum. Circulation 113(4):e56CrossRefPubMed

28.

Conway J, Hancock Friesen C, Thompson D, Warren A (2008) Fetal diagnosis of an “extra cardiac chamber”. Pediatr Cardiol 29(1):188–190CrossRefPubMed

29.

Erek E, Odemis E, Tanidir I (2013) Right ventricular diverticulum and associated cyst. Pediatr Cardiol 34(8):2093–2095CrossRefPubMed

30.

El Kady D, Gersovich E, Moon-Grady A, Towner D, McGahan J, Rhee-Morris L, Naderi S (2005) Congenital cardiac left ventricular aneurysm with pericardial effusion: early prenatal diagnosis and intervention. J Ultrasound Med 24(7):1011–1015CrossRefPubMed

31.

Johnson J, Ryan G, Toi A, Smallhorn J (1996) Prenatal diagnosis of a fetal ventricular diverticulum associated with pericardial effusion: successful outcome following pericardiocentesis. Prenat Diagn 16(10):954–957CrossRefPubMed

32.

Killen S, Mouledoux J, Kavanaugh-McHugh A (2014) Pediatric prenatal diagnosis of congenital heart disease. Curr Opin Pediatr 26(5):536–545CrossRefPubMed

33.

Carles D, Maugey-Laulom B, Habboud H, Alberti E, Weichhold W, Leger F (1995) Early prenatal diagnosis of ventricular diverticulum complicated by serous pericardial effusion. Prenat Diagn 15(8):778–780CrossRefPubMed

34.

Cesko I, Hajdu J, Csapo Z, Toth T, Sipos B, Papp Z (1998) Fetal hydropericardium associated with left ventricular diverticulum. Prenat Diagn 18(7):721–724CrossRefPubMed

35.

Sepulveda W, Drysdale K, Kyle P, McNeal A, Moore I (1996) Congenital left ventricular aneurysm causing hydrops fetalis: prenatal diagnosis with color Doppler ultrasonography. J Ultrasound Med 15(4):327–331CrossRefPubMed

36.

Papagiannis J, Van Praagh R, Schwint O, D’Orsogna L, Qureshi F, Reynolds J, Kallfelz C, Nozar J (2001) Congenital left ventricular aneurysm: clinical imaging, pathologic and surgical findings in seven new cases. Am Heart J 141(3):491–499CrossRefPubMed

37.

Cavalle-Garrido T, Cloutier A, Harder J, Boutin C, Smallhorn J (1997) Evolution of fetal ventricular aneurysms and diverticula of the heart: an echocardiographic study. Am J Perinatol 14(7):393–400CrossRefPubMed

38.

Sherman S, Leenhouts K, Utter G, Litaker M, Lawson P (1996) Prenatal diagnosis of left ventricular aneurysm in the late second trimester: a case report. Ultrasound Obstet Gynecol 7(6):456–457CrossRefPubMed

39.

Chaubal N, Dighe M, Shah M, Chaubal J, Raghavan J (2004) Congenital left ventricular aneurysm: prenatal sonographic diagnosis. J Ultrasound Med 23(1):125–128CrossRefPubMed

40.

Jowett V, Miller O (2011) Prenatal diagnosis of left ventricular aneurysm in association with interruption of the aortic arch. Cardiol Young 21(1):113–115CrossRefPubMed

41.

Vernon M, Rutledge J, Kemma M (2014) In utero evolution of an apical left ventricular aneurysm. Circulation 130(22):1982–1983CrossRefPubMed

42.

Patel C, Judge N, Muise K, Levine M (1996) Prenatal myocardial infarction suspected by fetal echocardiography. J Am Soc Echocardiogr 9(5):721–723CrossRefPubMed

43.

Weichert J, Chiriac A, Axt-Fliedner R (2010) Fetal diagnosis of left ventricular aneurysm of the free wall and the interventricular septum: report of two cases and review of the literature. J Matern Fetal Neonatal Med 23(12):1510–1515CrossRefPubMed

44.

Kitchiner D, Leung M, Arnold R (1990) Isolated congenital left ventricular diverticulum: echocardiographic features in a fetus. Am Heart J 119(6):1435–1437CrossRefPubMed

45.

Brachlow A, Sable C, Smith S, Slack M, Martin G (2002) Fetal diagnosis and postnatal follow-up of an asymptomatic congenital left ventricular diverticulum. Pediatr Cardiol 23(6):658–660CrossRefPubMed

46.

Pradhan M, Dalal A, Kapoor A, Kumar S, Manisha A (2008) Fetal left ventricular diverticulum presenting as dysrhythmia: diagnosis and management. Fetal Diagn Ther 23(1):10–14CrossRefPubMed

47.

Paoletti D, Robertson M (2012) Prenatal diagnosis of a left ventricular diverticulum. Am J Ultrasound Med 15(3):112–114CrossRef

48.

Peters C, Wacker-Gussmann A, Strasburger J, Cuneo B, Gotteiner N, Gulecyuz M, Wakai R (2015) Electrophysiologic features of fetal ventricular aneurysms and diverticula. Prenat Diagn 35(2):129–136CrossRefPubMed

49.

Gembruch U, Steil E, Redel D, Hansmann M (1990) Prenatal diagnosis of a left ventricular aneurysm. Prenat Diagn 10(3):203–209CrossRefPubMed

50.

Hornberger L, Dalvi B, Benacerraf B (1994) Prenatal sonographic detection of cardiac aneurysms and diverticula. J Ultrasound Med 13(12):967–970CrossRefPubMed

51.

Pipitone S, Sperandeo V, Mongiovi M, Roberto G, Centineo G (2002) Prenatal diagnosis of ventricular aneurysm: a report of two cases and a review. Prenat Diagn 22(2):131–136CrossRefPubMed

52.

Chiang Y, Yang C, Shih J, Lee C (2006) Prenatal diagnosis of congenital left ventricular aneurysm by four-dimensional ultrasonography with spatio-temporal image correlation (STIC). Ultrasound Obstet Gynecol 28(3):345–347CrossRefPubMed

53.

Balakumar K (2009) Prenatal diagnosis of left ventricular aneurysm. Indian J Radiol Imaging 19(1):84–86CrossRefPubMedPubMedCentral

54.

Fujita Y, Hidaka N, Yumoto Y, Morihana E, Fukushima K, Wake N (2012) Measurement of the fetal isovolumetric contraction time in the fetus with a left ventricular aneurysm. J Obstet Gynaecol Res 38(3):586–588CrossRefPubMed

55.

Gardiner H, Wimalasundera R, Pasquini L, Wawryk S, Ho S (2005) Images in cardiovascular medicine. Pericardiocentesis at 14 weeks: effective treatment of pericardial effusion complicating right ventricular diverticulum. Circulation 112(9):e120CrossRefPubMed

56.

Koshiishi T, Osada H, Hata A, Furugen Y, Murakoshi T, Mitsuhashi N (2007) Prenatal rupture of right ventricular diverticulum: a case report and review of the literature. Prenat Diagn 27(12):1154–1157CrossRefPubMed

57.

John J, Bricker J, Fenrich A, Vick G, El-Said H, Ayres N, Bezold L (2002) Images in cardiovascular medicine. Fetal diagnosis of right ventricular aneurysm associated with supraventricular tachycardia with left bundle-branch block aberrancy. Circulation 106(1):141–142CrossRefPubMed

58.

McCaffrey F (2002) Around PediHeart: aneurysm of the right ventricular apex in a 24-week fetus. Pediatr Cardiol 23(1):8CrossRefPubMed

Title: Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature
Publication date: 01-02-2020
Keywords: Echocardiography
Aneurysm
Aneurysm
Pericardiocentesis
Echocardiography
Published in: Pediatric Cardiology / Issue 2/2020
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-019-02252-7

ACC 2024 Congress Coverage

Heart Failure Video

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Prenatally Diagnosed Congenital Ventricular Outpouchings: An Institutional Experience and Review of the Literature

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2020

Upcoming Events in Pediatric Cardiology

Left Superior Vena Cava in the Fetus: A Rarely Isolated Anomaly

Evidence of Systemic Absorption of Enteral Budesonide in Patients with Fontan-Associated Protein-Losing Enteropathy

Risk Factors and Predictors of Cardiac Erosion Discovered from 12 Japanese Patients Who Developed Erosion After Atrial Septal Defect Closure Using Amplatzer Septal Occluder

The Benefits and Bias in Neurodevelopmental Evaluation for Children with Congenital Heart Disease

Clinical Profile and Long-Term Follow-Up of Children with Brugada Syndrome

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page