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      Fetal Diagnosis of Left Ventricular Aneurysm: A Case Report

      case-report

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          Abstract

          Congenital left ventricular aneurysm is a rare but potentially lethal condition. We describe a case of isolated congenital left ventricular aneurysm diagnosed at 28 weeks' gestation. In addition to standard imaging, we utilized color-coded transthoracic tissue Doppler techniques to further evaluate the aneurysm postnatally.

          Most cited references10

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          Diagnosis and outcome in congenital ventricular diverticulum and aneurysm.

          Eloi Marijon, Phalla Ou, Laurent Fermont … (2006)
          True congenital ventricular diverticulum and aneurysm in children are very uncommon. We report our experience to clarify the diagnosis and outcome of these little-known entities. Twenty-two patients with congenital ventricular outpouchings were identified in our database from 1973 to 2004. Morphologic characteristics (localization, connection to a ventricle, contractility), histologic findings, and cardiac and/or extracardiac abnormalities were analyzed in all 22 patients. Cardiovascular events and clinical courses were reviewed. Congenital ventricular diverticula (n = 16) were characterized by synchronal contractility and three myocardial layers on histologic examination. Two categories of congenital ventricular diverticulum could be identified with regard to their localization: apical and nonapical. Apical diverticula (n = 8) were always associated with midline thoracoabdominal defects and other heart malformations. Nonapical diverticula (n = 8) were always isolated defects. Congenital ventricular aneurysms (n = 6) were characterized by akinesis with paradoxical systolic motion, wide connection to the ventricle, fibrosis on histologic examination that appeared with high signal on T2 weighted magnetic resonance imaging, and absence of other heart or midline thoracoabdominal defects. The outcome was different in these two types of outpouchings: congential ventricular aneurysms were associated with adverse outcomes whereas the prognosis for congenital ventricular diverticula was good. Congenital ventricular diverticulum and aneurysm are two distinct entities, with different histologic and morphologic characteristics and outcomes. Assessment of these differential characteristics is of importance for prenatal counseling.
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            Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases.

            Heidi Reynolds, J Papagiannis, L. J. D’Orsogna … (2001)
            Congenital left ventricular aneurysm is a poorly understood and potentially lethal entity. Methods and Results In a clinicopathologic study of 7 new cases, the major presenting features in 6 patients were congestive heart failure in 4, ventricular arrhythmias in a 32-week fetus, and multiple congenital anomalies in a fetus with trisomy 13. Accurate diagnosis was achieved in all 3 living patients by echocardiography, angiocardiography, and magnetic resonance imaging. The aneurysm was predominantly apical in 3 and involved most of the left ventricular free wall in 4. Of the 3 living patients, medical management alone sufficed in 2. The third, a newborn boy, underwent a new and successful aneurysm-exclusion left ventriculoplasty. The mitral valve was abnormal in all 4 autopsied cases, the papillary muscles being short, thin, or absent. The aneurysm was thinner and its area was larger than that of the nonaneurysmal left ventricle in all necropsied patients. Congenital left ventricular aneurysm appears to be a developmental anomaly, an idiopathic dysplasia of left ventricular endocardium and myocardium. No evidence of a viral etiology was found. Some neonates can be managed medically, but others require urgent surgical intervention. A new surgical operation is presented, a functional left ventricular aneurysmectomy that minimizes intraoperative and postoperative blood loss and that preserves the coronary arteries.
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              Prenatal diagnosis of a left ventricular aneurysm.

              M Hansmann, E Steil, D Redel … (1990)
              In a fetus with ventricular extrasystoles a congenital aneurysm of the left ventricle was diagnosed prenatally. At 32 weeks of gestation, echocardiography showed a large apical left ventricular aneurysm with a thin, hypokinetic wall. Congestive heart failure did not occur. Prenatal and postnatal examinations did not detect the aetiology of the aneurysm, but excluded the majority of possible causes. The 2-year-old child is now asymptomatic and normally developed. Neither medication nor surgical treatment have been necessary, except for antithrombotic prophylaxis with low-dose aspirin.
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                Author and article information

                Journal
                Journal ID (nlm-ta): AJP Rep
                Journal ID (iso-abbrev): AJP Rep
                Title: AJP Reports
                Publisher: Thieme Medical Publishers (333 Seventh Avenue, New York, NY 10001, USA. )
                ISSN (Print): 2157-6998
                ISSN (Electronic): 2157-7005
                Publication date (Electronic): 22 July 2011
                Publication date (Print): December 2011
                Volume: 1
                Issue: 2
                Pages: 91-94
                Affiliations
                [1 ]Department of Obstetrics, Gynecology, and Women's Health, Minneapolis, Minnesota
                [2 ]Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
                Author notes
                Address for correspondence and reprint requests Shanthi Sivanandam, M.D. Department of Pediatrics, University of Minnesota, 420 Delaware Street SE MMC 94, Minneapolis, MN 55455 silv0099@ 123456umn.edu
                Article
                Publisher ID: 01091
                DOI: 10.1055/s-0031-1284221
                PMC ID: 3653530
                PubMed ID: 23705094
                SO-VID: 57db8e3f-e647-45e0-81b6-b4ebca2ec04e
                Copyright © © Thieme Medical Publishers
                History
                Date received : 24 March 2011
                Date accepted : 12 May 2011
                Categories
                Subject: Article

                Keywords: fetal echocardiography,ventricular aneurysm,congenital heart disease,ultrasound
                Data availability:
                Keywords: fetal echocardiography, ventricular aneurysm, congenital heart disease, ultrasound

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