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Forum Name: Congenital Heart Disease in Adults

Question: Finding new heart defects


 sally - Thu Sep 25, 2003 1:41 pm

Hi and thanks for the forum.
I will be 50 in a few months, having had surgery for TOF and PDA as a teen. I had an ablation (RVOT) in 2000. My last cath was about 2 years ago at which time they found a small apical diverticulum in the left ventricle. From what I understand, this is not very common and I am not getting much information about it and it wasn't even talked about by my cardiologist at the time. I did read though, that diverticulums are often mis-read and may be aneurysms instead. How would I know this? My main concern is why hasn't this been seen ever before throughout all my caths and procedures and echoes? Is it just that the equipment was better with this hosp's cath lab? Could this NOT be congenital and just develop over my lifetime? Would this mean it's more aneurysm than diverticulum? May this enlarge or rupture and SHOULD it be a concern and be treated? Is this a common finding along with my TOF and PDA and bicuspid aortic valve? I also some has secondary pulmonary hypertension but am not treated for this. I feel ok when just sitting but often get very SOB with minor exertion; last echo was beginning of 2003 (prior to AICD placement for syncope and V-tach) and nothing was new or of concern, although this left ventricular diverticulum was only mentioned once and that was in the cath they did in 1/02. Sorry for the round-about questions! I feel like I would totally bother my cardiologist (a pediatric one) because he is so exceptionally busy with the sick children and I am one of the healthiest TOF's around!!
I just don't want to be stupid or neglecting something if I can get ahead of it.
Thank you SO much for any information you can provide!!
 Dr. Yasser Mokhtar - Sat Oct 11, 2003 12:28 pm

User avatar Dear Sally,

Thank you very much for using our website.

A left ventricular diverticulum is a very rare condition. It is usually associated with congenital heart disease. Since they are usually asymptomatic, if they islolated (not associated with congenital heart disease) sometimes they are discovered late in life.

There are two types of diverticula, the first type is formed of the three layers of the heart. The second is formed of fibrous tissue mainly. They could be differentiated based on the fact that the first type contains heart muscle fibers and usually contracts as the heart and this should be obvious whether during echo or cath.

Their complication include rupture and thrombus formation and embolization. Rupture is more common with the second type (firbous tissue type), however.

There is no consensus agreement or guidelines to treat those.

The difference between an aneurysm and a diverticulum is the size of the communication with the heart. In case of aneurysms the communication is wide while with diverticula the communication is small. i guess if you had an aneurysm they would have called it an aneurysm. However, in the second type of diverticula, the connection with the ventricle is wide. Usually the first type arises from the apex while the second may arise from both the apex and of the base of the ventricle

In your condition, i can not answer the questions that you have about why it was not discovered before or why no one talked to you about.

Personally, i would assume that the diverticulum was not there since first you had an open heart surgery to correct your congenital heart disease and if it was there i would assume that they would have taken care of it then. Could have it been missed? i guess it could. Second, you had several caths before and it was not there and it should be obvious on them. You can have all your caths films reviewed if you like.

Does it make any difference if you find out whether you had before or developped it recently?

Yes, and this is because from your history you had v-tach and you had to have an aicd placed.

What is the importance? This diverticulum could be the cause of the v-tach after all. And the next question would be is removing the diverticulum going to solve the v-tach problem? Could be, but you are going to need the aicd after all so why take the risk of surgery?

My suggestion is that you should have this diverticulum followed by echocardiogram at least every year to see if it is getting larger.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.
 sally - Wed Oct 15, 2003 10:42 am

Doctor, thank you so much for your great reply and for making so much sense for me! I'm sorry so do this but I have an additional question pertaining to this:
If this LV Divertic. was just discovered and described during my last cath, and it was not mentioned on the echo I had some months later, how can I follow the size of it with echo? Do you think the person who did the last echo (the one directly prior to insertion of AICD) perhaps didn't see it or think it was anything because it's a rare thing and was not looking for it - and should I have mentioned it beforehand - ? In other words, do I have to have caths to follow it or do you think echoes in the future - as long as people know it exists - will be ok to follow the growth of the diverticulum?

Also, what is your opinion of adults with congenital heart disease seeing pediatric cardiologists? I have heard differing opinions from everyday folks saying pediatric docs are more familiar with the configuration/anatomy of congenital heart disease but they are unable to think of the future heart things we all may get in addition to our prior existing heart conditions like needing valve replacements, etc. Also, if I have a bicuspid aortic valve that is mild-moderately leaking, when should it be repaired - if ever? ....Should one go out of their way to a large "Center" like UCLA or Mayo who has both pediatric and adult cardio's on staff and who work as a team?

Thanks again very much for this forum and for your help. We are so happy to have answers.

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