Prenatal diagnosis of left ventricular aneurysm

Abstract Fetal cardiac anomalies involving the ventricular and atrial septa, outflow tracts, chambers, and valves are often encountered in routine screening. However, the prenatal detection of a fetal left ventricular aneurysm is rare. This report describes the case of a left ventricular aneurysm that was diagnosed at 24 weeks of gestation; the diagnosis was later confirmed by postnatal echocardiography. This case is reported because of its rarity and the characteristic echocardiographic findings. An early specific antenatal USG diagnosis helps in prognostication and in counseling of the parents.


Introduction
We would like to report the case of a left ventricular aneurysm diagnosed at 24 weeks of gestation.The diagnosis was eventually conÞ rmed on postnatal echocardiography.

Discussion
With the advent of sophisticated machines and soft ware, fetal echocardiography has become a very useful investigation.The detection rates of cardiac anomalies are increasing, as also the speciÞ city of the diagnoses. [1]In one recent report, the overall prevalence of cardiac anomalies at birth was 7.8/1000, inclusive of still births, live births and termination of pregnancy due to congenital heart disease. [2]Ventricular aneurysm is a recent addition to the list of diseases that can be diagnosed before birth; the Þ rst case was reported in 1990 [3] and approximately 20 cases have been reported till 2005. [4]The reported incidence is 0.5 per 100,000 live births.Classically, the USG diagnosis of a ventricular aneurysm is made based on the presence of a wide-mouthed ventricular outpouching along with the presence of paradoxical systolic expansion, though this may not always be seen.The aneurysm may arise from the ventricular septum, the wall, or the apical region.This fetus showed no other intra-or extracardiac anomaly; other anomalies are only rarely associated with such aneurysms. [5]ventricular diverticulum has to be diff erentiated from an aneurysm.A diverticulum is usually a small Þ ngerlike, synchronously contracting, narrow projection, which shows the same thickness and layering as the rest of the myocardium. [6]Fetuses with an isolated diverticulum have a good prognosis if the associated complications are treated. [7,8]Sometimes they have midline anomalies as in pentalogy of Cantrell.Ebstein's anomaly, cardiomyopathy, outß ow tract obstruction, and substantial atrioventricular regurgitation may all be confused with a right ventricular diverticulum. [9]The diff erential diagnosis of ventricular aneurysm also includes post-ischemic aneurysm.Other lesions that can occur in the vicinity, such as intrathoracic cystic anomalies (e.g., intrathoracic lung cysts), diaphragmatic hernia, absent right sided pericardium, Uhl's anomaly, and right ventricular dysplasia, should also be considered in the diff erential diagnoses.
The prognosis of a fetal left ventricular aneurysm depends on the time of detection, the size and the progression of the aneurysm, the presence or absence of compression of the fetal lungs, involvement of the mitral opening, reversal of atrial shunt, associated cardiac failure, and the presence of myocardial damage or connective tissue disorders. [5,10,11]is fetus was delivered by a Cesarian section for purely obstetric indications, and the postnatal detailed echocardiography conÞ rmed the antenatal diagnosis.
Balakumar: Prenatal diagnosis of left ventricular aneurysm

Figure 1 :
Figure 1: The four-chamber view of the fetal heart shows normal-sized atria (RA -right atrium, LA -left atrium), and right ventricle (RV).The left ventricle (LV) is massively dilated and the aorta (A) can be traced arising from it.The fetal head is in the lower uterine cavity and the fetal spine (SP) is along the left side of the mother

Figure 2 :
Figure 2: An enlarged representation of the four-chamber view shows the intact interventricular septum between the ventricles (RV -right ventricle, LV -left ventricle).The foramen ovale is seen between the atria (RA -right atrium, LA -left atrium).The aneurysm is directed posteriorly and to the left (arrow); it has a very thin wall and a broad communication with the ventricle.The aneurysmal dimensions remained almost unchanged during ventricular contraction, which was suggestive of dyskinesia.The fetal head (HD) is in the lower pole and the spine (SPL) is along the maternal left side.