Fetal Diagnosis of Left Ventricular Aneurysm: A Case Report

Abstract

Congenital left ventricular aneurysm is a rare but potentially lethal condition. We describe a case of isolated congenital left ventricular aneurysm diagnosed at 28 weeks' gestation. In addition to standard imaging, we utilized color-coded transthoracic tissue Doppler techniques to further evaluate the aneurysm postnatally. KEYWORDS: Fetal echocardiography, ventricular aneurysm, congenital heart disease, ultrasound Congenital left ventricular aneurysm is a rare but potentially lethal cardiac anomaly. We describe a case of isolated congenital left ventricular aneurysm diagnosed at 28 weeks' gestation. Standard diagnostic techniques were augmented with color-coded transthoracic tissue Dop-pler imaging to further evaluate the aneurysm postnatally. CASE REPORT A 22-year-old woman, gravida 4, para 2, was referred for an abnormal cardiac finding on a comprehensive obstet-ric ultrasound performed at 28 weeks' gestation. Due to late prenatal care, this was the patient's first ultrasound in the pregnancy. The left ventricle of the fetus was described as having an hourglass-like shape, and there was concern for irregular contractility. No other fetal abnormalities were identified, and there was no evidence of fetal hydrops. The patient had no significant past medical history and denied exposure to teratogens during the pregnancy. She did report symptoms consistent with a viral illness at 5 to 6 weeks' gestation. A fetal echocardiogram demonstrated a discrete segment of the apical left ventricular wall that exhibited a thin-walled outpouching with a wide communication to the left ventricular cavity (Fig. 1). The left ventricular volume and the aneurysm were measured by tracing the endocardium using a single-plane ellipse calculation. The left ventricular aneurysm measured 11 Â 13 mm in diameter, and the neck of the aneurysm measured 5 mm. The aneurysm volume in diastole was 1.1 mL. The ratio of aneurysm volume to left ventricular volume in diastole was 0.5, and the left ventricular myocardial performance index was 0.4. The measurements from subsequent echocardiograms are reported in Table 1. Color flow imaging showed abnormal low-velocity turbulent flow in the pouch, but there was no demonstrable contraction during systole. None of the prenatal echocardiograms revealed thrombus within the aneurysm, arrhythmia, or pericardial effusion. The mitral valve apparatus consistently appeared normal, and there was no mitral insuffi-ciency noted. An elective induction and delivery occurred at 39 weeks' gestation. The infant weighed 6 pounds, 11 ounces. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The infant was transferred to the neonatal intensive care unit for further evaluation. A postnatal