Double-chambered left ventricle: a diagnosis made by multimodality imaging

Excerpt

A 30-year-old woman presented at 13 weeks gestation with palpitations. Exam, laboratories, electrocardiogram and Holter were normal. Echocardiogram (Fig. 1a, Video 1) showed double-chambered left ventricle (LV). Color and pulse-wave Doppler showed normal flow pattern at the mouth of the diverticulum without flow acceleration (systolic velocity 68 cm/s, diastolic velocity 55 cm/s). Blood entered the diverticulum in diastole and was ejected out of it in systole, just as occurs in the normal LV (Fig. 1b, c). Cardiac MRI (CMR) showed a large diverticulum in the mid-inferolateral LV (52 mm × 18 mm × 25 mm). There was no thrombus. Biventricular size, systolic function, wall motion, pericardium and valves were all normal (Fig. 1 e, f, Video 2). There was no evidence of noncompaction. Gadolinium contrast could not used due to pregnancy. To differentiate between fibrous versus muscular diverticulum, feature-tracking strain was done (Fig. 1g, Video 3). Systolic strain values were normal indicating that the diverticulum was composed of contractile, healthy myocardium. Fetal echocardiogram showed no abnormalities. She delivered a healthy baby vaginally at term and has had no further symptoms for over 1 year now.

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