A Congenital Left Ventricular Aneurysm: A Cause of Premature Ventricular Complex in a Premature Infant
Journal
Pediatrics and Neonatology
Journal Volume
58
Journal Issue
2
Pages
196-197
Date Issued
2017
Author(s)
Abstract
A 1-day-old premature male was born at a gestational age of 31 weeks via a caesarean-section due to frequent bradycardia with decreased fetal movements. His mother came to our hospital with frequent uterine contractions and a preterm premature rupture of the membrane at a gestational age of 26 weeks. A fetal echocardiography revealed an irregular heart beat with minimal heart rate of around 70 bpm without pericardial effusion. After birth, a 12-lead electrocardiogram showed premature ventricular complex (PVC) bigeminy in a right-bundle branch block pattern (Figure 1). A large outpouching structure derived from the left ventricular posterior wall near the apex was clearly documented on a trans-thoracic echocardiograph. The wall of the outpouching was thin (0.053 cm), and the neck was wide (0.639 cm) (Figures 2A and 2B). In addition, the contraction of the outpouching was dyskinetic and asynchronous to the left ventricle (Movie S1). Three-dimensional contrast-enhanced computed tomographic and virtual cardioscopic images1Yang J.C. Chen Y.S. Chen S.J. Shih T.T. Virtual cardioscopy-guided surgical resection for left ventricular outflow tract obstruction.J Am Coll Cardiol. 2011; 58: e31Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar and animations showed a thin-walled outpouching with a smooth inner surface without trabeculation (Figures 3A and 3B, Movie S2). The above images are compatible with a congenital left ventricular aneurysm of the large type IIc left ventricular outpouching (LVO), according to the new classification proposed by Malakan et al.2Malakan Rad E. Awad S. Hijazi Z.M. Congenital left ventricular outpouchings: A systematic review of 839 cases and introduction of a novel classification after two centuries.Congenit Heart Dis. 2014; 9: 498-511Crossref PubMed Scopus (23) Google Scholar We started digoxin for congestive heart failure and low-dose aspirin to prevent thromboembolism.3Papagiannis J. Van Praagh R. Schwint O. D'Orsogna L. Qureshi F. Reynolds J. et al.Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases.Am Heart J. 2001; 141: 491-499Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar Although he was discharged at the postmenstrual age of 35+1 weeks after the electrocardiogram resumed as normal, a future elective aneurysmectomy will still be arranged for his large type IIc LVO, which is at a high risk of spontaneous rupture.2Malakan Rad E. Awad S. Hijazi Z.M. Congenital left ventricular outpouchings: A systematic review of 839 cases and introduction of a novel classification after two centuries.Congenit Heart Dis. 2014; 9: 498-511Crossref PubMed Scopus (23) Google ScholarFigure 2An echocardiography at the diagnosis. (A) The long-axis view shows a LV aneurysm (arrow) coming from the posterior wall, with a wide communication to LV (0.639 cm), a decreased wall thickness (0.053 cm), and a large longitudinal diameter (1.41 cm). (B) An apical four-chamber view (A4C) depicts the LV aneurysm derived from the LV apex. See Movie S1, an echocardiography movie of long-axis and four-chamber views in slow motion. AO = aorta; LA = left atrium; LV = left ventricle.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3(A) A three-dimensional contrast-enhanced cardiac computed tomographic image in a left anterior oblique view shows a large bulging aneurysm (arrow) derived from the LV posterior apex. (B) A virtual cardioscopic image showing the orifice (dotted circle) of the LV aneurysm from inside the LV. The cardioscopic image demonstrates the structures looking into the LV from the LV outflow tract (solid arrow on 4C and apical long echo image). See Movie S2 for animation. A = anterior papillary muscle; P = posterior papillary muscle; S = septum.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The following is the supplementary data related to this article:eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3MjExMjE3OWU3MmU5NmQxZDg1Y2M2Y2M3ODc1OWUyNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MTgyMTExfQ.hMbI92W-DqP03BZB_c7XtVmLXaR2Io1uYcKEgWD07UNmMsTJJDrv6EgBz8oKUGuv3-laqVjToxHP03Sfuq98yIpyyBRxDbcRht8bJFahqYwoR7bCVSMF6wFXA4KjIyIOnLjZ3Uu_A4ZSBk_2EuBYtC33l9pW_CwXXpxoVIGeoIvIRsppmy30dWq0YwABDIA7Fz0X44FpAQjfofinn9QKVpZtipJJobnVScWPiCc3MD0Z7wfb3vJrJQVGCFCht6jmx3_3P1PIhBvR9O4sa7rog7KPb0xcwIAjmilbFhExqiC-lldgGUYwxtGy2pqP4rMIGh28k51meGwAnIwjuHhLxg(mp4, (2.04 MB) Download video eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI3MjExMjE3OWU3MmU5NmQxZDg1Y2M2Y2M3ODc1OWUyNiIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjc4MTgyMTExfQ.hMbI92W-DqP03BZB_c7XtVmLXaR2Io1uYcKEgWD07UNmMsTJJDrv6EgBz8oKUGuv3-laqVjToxHP03Sfuq98yIpyyBRxDbcRht8bJFahqYwoR7bCVSMF6wFXA4KjIyIOnLjZ3Uu_A4ZSBk_2EuBYtC33l9pW_CwXXpxoVIGeoIvIRsppmy30dWq0YwABDIA7Fz0X44FpAQjfofinn9QKVpZtipJJobnVScWPiCc3MD0Z7wfb3vJrJQVGCFCht6jmx3_3P1PIhBvR9O4sa7rog7KPb0xcwIAjmilbFhExqiC-lldgGUYwxtGy2pqP4rMIGh28k51meGwAnIwjuHhLxg(mp4, (2.04 MB) Download video PVCs in premature infants are not unusual. However, a congenital left ventricular aneurysm is a rare disease entity occurring in 0.5 per 10,000 live births. It is regarded as an idiopathic endomyocardial dysplasia,3Papagiannis J. Van Praagh R. Schwint O. D'Orsogna L. Qureshi F. Reynolds J. et al.Congenital left ventricular aneurysm: clinical, imaging, pathologic, and surgical findings in seven new cases.Am Heart J. 2001; 141: 491-499Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar and is sometimes accompanied by ventricular tachycardia, PVCs, and congestive heart failure. Complications including thromboembolism, a rupture of the aneurysm, and sudden death have been reported. Malakan et al.2Malakan Rad E. Awad S. Hijazi Z.M. Congenital left ventricular outpouchings: A systematic review of 839 cases and introduction of a novel classification after two centuries.Congenit Heart Dis. 2014; 9: 498-511Crossref PubMed Scopus (23) Google Scholar proposed a new classification system for LVOs to distinguish high-risk groups with a poor prognosis.2Malakan Rad E. Awad S. Hijazi Z.M. Congenital left ventricular outpouchings: A systematic review of 839 cases and introduction of a novel classification after two centuries.Congenit Heart Dis. 2014; 9: 498-511Crossref PubMed Scopus (23) Google Scholar A surgical aneurysmectomy for a high-risk group is suggested. The authors have no conflicts of interest relevant to this article.
SDGs
Type
journal article