Congenital Left Ventricular Outpouching ( Lvo )

1685 Words Apr 9th, 2016 7 Pages
Congenital left ventricular outpouching (LVO) is an uncommon perinatal diagnosis. Various terms used in the medical literature to describe the LVO are a source of perplexity. The novel classification developed in a recent review by Rad et al attempting to provide a clear differentiation of the mixed definitions based on anatomical and cardiac imaging data. Our report presents a case series of prenatal diagnosis of LVO. The application of Rad et al original classification and its impact on the patients’ outcome are discussed.

Introduction:
Congenital left ventricular outpouching (LVO) is a rare disorder in which a confined protrusion arises from the left ventricular (LV) free wall. The terms LV aneurysm, LV diverticulum,
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Antenatal fetal echocardiogram at 37 weeks gestation showed a thin walled LV outpouching (LVO) of the LV free wall via a wide connection (Figure 1-A). Ventricular systolic function was qualitatively fair with no pericardial effusion. Bidirectional flow was determined by color Doppler evaluation between the LVO and LV. Postnatal transthoracic echocardiogram (Figure 1-B) and cardiac catheterization confirmed the antenatal diagnosis and showed normal coronary artery origins and distributions. Cardiac MRI without gadolinium showed a thin walled hypokinetic outpouching from the LV free wall near the LV apex. The LV systolic function was decreased with an ejection fraction of 15.8%. Anti-heart failure medications were initiated, in addition to Aspirin for thrombosis prophylaxis.
The infant was monitored for ventricular arrhythmia while in the hospital. Accordingly, he was discharged home with close outpatient follow-up. Over several months, his cardiac function deteriorated with significant LV dilatation recognized by echocardiogram and cardiac MRI with gadolinium enhancement. Interestingly, however, he continued to be free of arrhythmias by repeated Holter monitor evaluations. He did develop failure to thrive even with optimal caloric intake. He subsequently received cardiac transplantation at one year of age and succumbed at 3 years of age due to post transplant complications.
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