Dipak Niraj Kumar, Venkatesh Sumitra, Prabhu Shakuntala, Rao Sudha
Department of Neonatology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, aIndia.
Department of Pediatric Cardiology, B J Wadia Hospital for Children, Nowrosjee Wadia Maternity Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, bIndia.
J Saudi Heart Assoc. 2017 Jul;29(3):203-210. doi: 10.1016/j.jsha.2016.10.004. Epub 2016 Oct 20.
Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA)/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele) and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.
心室膨出在产前超声检查中是一种罕见的发现，除先天性囊肿和裂隙外，主要的鉴别诊断包括憩室、动脉瘤和假性动脉瘤。先天性心室膨出的各种胎儿表现形式包括胎儿二维超声心动图上异常的四腔心视图、胎儿心律失常、胎儿水肿和心包积液。左心室动脉瘤（LVA）/非心尖憩室通常是孤立性缺陷。心尖憩室总是与胸腹部中线缺陷（上腹部搏动性憩室或巨大脐膨出）及其他心脏结构畸形相关。大多数LVA/先天性心室憩室患者临床上无症状，但可能会引发并发症，如室性快速心律失常、系统性栓塞、猝死、自发性破裂和严重瓣膜反流。无症状LVA和孤立性先天性心室憩室的治疗仍不明确。在本综述中，我们的目的是概述一种针对检测到心室膨出胎儿的系统方法。从患病率及其类型开始，讨论胎儿管理中的问题、出生后的自然病程和演变，最后讨论连续观察还是手术矫正这一长期存在的困境。
