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\begin{document}

\title{Left ventricular pseudo-aneurysm complicating a ruptured isolated
congenital diverticulum}



\author[1]{Liang Fang}%
\author[2]{Chao Xue}%
\author[3]{Ying Zhao}%
\author[4]{Zhaoying Wen}%
\author[5]{Michael Henein}%
\affil[1]{Chengde Medical College Affiliated Hospital}%
\affil[2]{Affiliation not available}%
\affil[3]{Beijing Anzhen Hospital, Capital Medical University}%
\affil[4]{Beijing Anzhen Hospital, Capital Medicical University}%
\affil[5]{Umea University}%


\vspace{-1em}



  
  \date{June 10, 2024}


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\begin{abstract}
We report a case of 41-year-old woman who presented with chest tightness
and shortness of breath. Transthoracic echocardiogram (TTE) showed left
ventricular (LV) pseudo-aneurysm of the inferior wall with preserved LV
systolic function. Coronary angiogram was normal. Surgical repair of the
pseudo-aneurysm with a pericardial patch was performed, and pathological
results confirmed rupture of an isolated congenital LV diverticulum.as
the most likely etiology.%
\end{abstract}%



\sloppy


\textbf{Left ventricular pseudo-aneurysm complicating a ruptured
isolated congenital diverticulum}

Liang Fang MD.\textsuperscript{1}, Chao Xue MD.\textsuperscript{2}, Ying
Zhao PhD, MD\textsuperscript{2}, Zhaoying Wen PhD,
MD\textsuperscript{3}, Michel Y Henein MSc, PhD, FESC\textsuperscript{4}

\begin{enumerate}
\tightlist
\item
  Department of Ultrasound, South Hospital District of Affiliated
  Hospital of Chengde Medical College, Chengde, Hebei, China
\item
  Department of Echocardiography, Beijing Anzhen Hospital, Capital
  Medical University, Beijing, China
\item
  Department of Radiology, Beijing Anzhen Hospital, Capital Medical
  University, Beijing, China
\item
  Institute of Public Health and Clinical Medicine, Ume\selectlanguage{ngerman}å University,
  Umeå, Sweden.
\end{enumerate}

Running title: A ruptured congenital left ventricular diverticulum

Corresponding Author

Michael Henein MSc PhD FESC

Professor of Cardiology

Department of Public Health and Clinical Medicine

Umeå University, Umeå, Sweden

michael.henein@umu.se

Tel: +46907850000~ Fax: +4690137633

\textbf{Abstract} \selectlanguage{english}:We report a case of 41-year-old woman who presented
with chest tightness and shortness of breath. Transthoracic
echocardiogram (TTE) showed left ventricular (LV) pseudo-aneurysm of the
inferior wall with preserved LV systolic function. Coronary angiogram
was normal. Surgical repair of the pseudo-aneurysm with a pericardial
patch was performed, and pathological results confirmed rupture of an
isolated congenital LV diverticulum.as the most likely etiology.

\textbf{Keywords} : left ventricular, pseudo-aneurysm, diverticulum

Congenital left ventricular (LV) diverticulum is a rare cardiac anomaly
which can be complicated with infective endocarditis, embolisms,
arrhythmia and, rarely, rupture\textsuperscript{1-4} . If ruptured, the
outcome is usually poor with high mortality.

A 41-year-old woman presented with a history of chest tightness and
shortness of breath for 6 months. On clinical examination, blood
pressure was 124/86 mmHg. A transthoracic echocardiography (TTE) showed
20 mm discontinuity (with narrow connection neck) of basal segment of
the inferior wall with 88 x 71 mm echo-free space, suggesting
pseudo-aneurysm formation wrapped within the pericardial (Fig 1A). There
was a marked thrombus in the pseudo-aneurysm with large pericardial
effusion (Fig 1B). Color Doppler demonstrated blood flow across the
narrow neck of the pseudo-aneurysm (Fig 1C). Overall LV systolic
function was preserved with no other combined abnormality. The patient
did not have any history of myocardial infarction, prolonged fever,
chest trauma or any cardiac surgery. Coronary angiogram confirmed normal
coronary arteries and cardiac magnetic resonance imaging (MRI) confirmed
the presence of the LV pseudo-aneurysm, on late gadolinium enhancement
(LGE) showing LV pseudo-aneurysm with thin wall corresponding to
fibrosis and/or scar (Fig 2A \& 2B).

The patient underwent surgery, during which a large pseudo-aneurysm of
LV inferior wall was confirmed with a thrombus inside. The
pseudo-aneurysm was closely adherent to the pericardium of the
diaphragmatic surface (Fig 3). Surgical repair with a pericardial patch
was performed, and postoperative TTE showed normal LV function with the
patch located at the inferior wall. Pathological investigations showed
the aneurysm size was 70 x 60 x 35 mm. Based on the imaging,
pathological results and medical history we considered that the
ventricular aneurysm was a congenital LV diverticulum, which ruptured
and caused a ventricular pseudo-aneurysm.

\textbf{References:}

1. Gowitt GT, Zaki SA. Rupture of a cardiac diverticulum resulting in
sudden death. \emph{Am J Forensic Med Pathol.} 1988;9(2):155-158.

2. Ohlow MA, von Korn H, Lauer B. Characteristics and outcome of
congenital left ventricular aneurysm and diverticulum: Analysis of 809
cases published since 1816. \emph{Int J Cardiol.} 2015;185:34-45.

3. Aquaro GD, Strata E, Di Bella G, et al. Prognostic role of isolated
left ventricular diverticuli detected by cardiovascular magnetic
resonance. \emph{J Cardiovasc Med (Hagerstown).} 2015;16(8):562-567.

4. Westaby S, Katsumata T, Runciman M, Burch M. Ruptured left
ventricular diverticulum in infancy. \emph{Ann Thorac
Surg.}1997;64(4):1181-1182.\selectlanguage{english}
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