Shrateh Oadi N, Abusamra Muttaz M M, Abudaoud Majdi A, Srour Moayad A, Hijjeh Nizar, Haymouni Nidal, Sbeitan Iyad, Abdelraziq Samer, Abutaqa Mohammed
Al-Quds University School of Medicine.
Department of Pediatric Cardiology, Al-Makassed Islamic Charitable Hospital, Jerusalem, Palestine.
Ann Med Surg (Lond). 2023 Mar 9;85(3):501-505. doi: 10.1097/MS9.0000000000000212. eCollection 2023 Mar.
Congenital left ventricular diverticulum (LVD) is a rare congenital cardiac anomaly and may be complicated by fatal adverse events such as diverticulum rupture. Most LVD cases are asymptomatic and often discovered incidentally. Herein, we describe an unusual and peculiar clinical presentation with felicitous surgical management of ruptured LVD.
A 10-day-old male infant presented with severe, intractable, and unexplained anemia associated with respiratory distress. Upon admission, the patient was clinically shocked with a hemoglobin level of 6.0 g/dl. As chest imaging showed cardiomegaly, echocardiography was performed and revealed a 9×10 mm diverticulum arising from the posterolateral wall of the left ventricle along with blood and clot collection in the pericardium. The patient underwent an urgent surgical resection of the diverticulum. He was followed up for 2 years without any readmissions or cardiac complaints.
Systemic thromboembolism, heart failure, infarction, and tachyarrhythmias have all been reported as complications of LVD. The most serious complication is diverticulum rupture, which can result in death. As a result, this congenital defect should be discovered early to determine the potential risks and plan appropriate treatment.
Congenital heart defects such as LVD should be suspected in neonates presenting with unexplained and intractable anemia. To avoid the diagnosis confusion and risk of serious complications in LVD patients, such as spontaneous rupture of the diverticulum, we advocate immediate surgical management of LVD in children.
先天性左心室憩室（LVD）是一种罕见的先天性心脏异常，可能并发致命的不良事件，如憩室破裂。大多数LVD病例无症状，常为偶然发现。在此，我们描述了一例LVD破裂的不寻常且特殊的临床表现及成功的手术治疗。
一名10日龄男婴因严重、难治且原因不明的贫血伴呼吸窘迫就诊。入院时，患者临床休克，血红蛋白水平为6.0 g/dl。胸部影像学显示心脏扩大，遂行超声心动图检查，发现左心室后壁有一个9×10 mm的憩室，心包内有血液和血凝块。患者接受了憩室紧急手术切除。随访2年，无再次入院或心脏不适。
系统性血栓栓塞、心力衰竭、梗死和快速性心律失常均被报道为LVD的并发症。最严重的并发症是憩室破裂，可导致死亡。因此，应尽早发现这种先天性缺陷，以确定潜在风险并制定适当的治疗方案。
对于出现原因不明且难治性贫血的新生儿，应怀疑存在LVD等先天性心脏缺陷。为避免LVD患者的诊断混淆和严重并发症风险，如憩室自发破裂，我们主张对儿童LVD立即进行手术治疗。
