Ann Thorac Surg 2002;74:599
© 2002 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Infravalvular left ventricular diverticulum
Takeshi Kobayashi, MD*a,
Toshiro Ito, MDa,
Tohru Mawatari, MDa,
Hideyuki Harada, MDa,
Tomio Abe, MDb
a Department of Thoracic Surgery, Hokkaido Prefectural Kushiro Hospital, Kushiro, Japan
b Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
* Address reprint requests to Dr Kobayashi, Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine, South 1 West 16, Chuo-ku, Sapporo 060-8556, Japan
e-mail: tkobaya{at}sapmed.ac.jp
A 21-year-old woman underwent cardiac evaluation because of continuous fever, easy fatigability, and diastolic murmur. Echocardiography (Fig 1A) demonstrated severe aortic regurgitation (Av = aortic valve; Div = diverticulum; LA = left atrium; LV = left ventricle); Figure 1B (arrow) indicates flow into the diverticulum. Left ventricular angiography in right anterior oblique projection showed the diverticulum just below the aortic valve (Fig 2, arrows) (Ao = ascending aorta; LV = left ventricle). As the laboratory data revealed aortitis syndrome, after a treatment with steroid, surgery for resection of the diverticulum and aortic root replacement was performed. An entry to this diverticulum was found between the left coronary cusp and the noncoronary cusp. Figure 3 (arrow) indicates the ostium of the diverticulum (LCC = left coronary cusp; NCC = noncoronary cusp; RCC = right coronary cusp). Histological study revealed that the wall of this diverticulum contained three cardiac layers (endocardium, myocardium, and pericardium) and consisted mainly of fibrous tissue.
