Ohlow Marc-Alexander
Department of Cardiology, Heart Center, Zentralklinik Bad Berka, Germany.
Cardiology. 2006;106(2):63-72. doi: 10.1159/000092634. Epub 2006 Apr 12.
A congenital left ventricular aneurysm or diverticulum is a rare cardiac malformation; 411 cases have been reported since its first description in 1816, and other cardiac, vascular or thoraco-abdominal abnormalities have been shown in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. Diagnosis can be made after exclusion of coronary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most congenital left ventricular aneurysms and diverticula are asymptomatic or may cause systemic embolization, heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging or left ventricular angiography, visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities and possible complications; treatment options include surgical resection especially in symptomatic patients, anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable cardioverter defibrillator in case of symptomatic ventricular tachycardia, occasionally combined with class I or III antiarrhythmic drugs.
先天性左心室动脉瘤或憩室是一种罕见的心脏畸形；自1816年首次描述以来，已报告411例，约70%的病例还伴有其他心脏、血管或胸腹异常。它似乎是一种发育异常，始于胚胎第4周。排除冠状动脉疾病、局部或全身炎症、创伤原因以及心肌病后可作出诊断。临床上，大多数先天性左心室动脉瘤和憩室无症状，或可能导致全身栓塞、心力衰竭、瓣膜反流、心室壁破裂、室性心动过速或心源性猝死。通过超声心动图、磁共振成像或左心室血管造影等影像学检查来确诊，这些检查可显示结构变化及伴随的异常情况。治疗方式必须个体化定制，取决于临床表现、伴随的异常情况及可能的并发症；治疗选择包括手术切除，尤其适用于有症状的患者；全身栓塞后进行抗凝治疗；对于有症状的室性心动过速，采用射频消融或植入植入式心脏复律除颤器，偶尔联合使用I类或III类抗心律失常药物。
