Congenital Ventricular Outpouchings (CVOs) Recesses, Diverticula, Aneurysms , Clefts and Crypts

1. Congenital Ventricular Outpouchings (CVOs),,,
Recesses, Diverticula, Aneurysms , Clefts and Crypts
By
M.Gibreel, FEBR
AHC & NHI

2. Recess .
Crypt & cleft .
Diverticulum .
Aneurysm

3. CVOs
 60% asymptomatic.
 The most common symptoms ,, syncope and rhythm disturbances (43%)
,,,, chest pain (39%) and embolic events (2%).
 Some apical outpouchings may resemble a Takotsubo cardiomyopathy
,,,,,, The clinical setting and the reversibility of the dyskinesia are the main
diagnostic features.

5. 1) Myocardial crypts and clefts
 Narrow, deep invaginations within the myocardium >>> disarray of the
myocardial fibers.
 Fissures = crevices = recesses =crypts= clefts.
 Recess is the smallest one <50% of the myocardial thickness , the cleft used
when u deal with HCM.
 Crypts , Crevices, Fissures & Clefts >50% of the myocardial thickness
 Location : Basal posterior septum and LV-free wall.
 Def in CMRI:
A) V- or U-shaped extension of blood signal in cines >50% of the thickness of
the adjoining compact myocardium in diastole, Never exceeds the pericardial
margin.
B) Narrowing /obliteration in systole.
C)No segmental contractility defects.

6.  partial crypts or recesses < 25%–50% of the wall thickness,,,, no clinical
significance.
 “Cleft” used in HCM >> narrow invaginations within the left ventricular
myocardium.
Cleft in HCM

7. 2)Diverticulum & Congenital Ventricular Diverticulum
(CVD)
 Described for the first time by O’Bryan in 1838.
A)finger-like protrusion from the internal cavity extending outside the epicardium.
B)Narrow neck .
 Diameter from 0.5 to 9 cm.
 May be multiple = ventricular diverticulosis.
 Apex and perivalvular area, never been found in the IVS.
 Types : muscular or fibrous.
 Fibrous diverticulum =pseudodiverticulum.
 Progressive enlargement and spontaneous rupture of a diverticulum have been
described.

8.  CVD isolated or associated with midline thoraco-abdominal congenital
abnormalities. CVD as part of a complex
 associations Include:
(1) median line abdominal wall defects (omphalocele) .
(2) inferior sternal defects (aplasia and cleft sternum).
(3) anterior diaphragmatic defects.
(4) diaphragmatic pericardium defects (absence of the inferolateral
pericardium).
(5) complex cardiac abnormalities.

9. Diverticulum
debatable

13. Diverticulum
The diverticulum is deep and extends beyond the myocardial wall .
Narrow neck
No scar

16. Ventricular Aneurysms
 Types : acquired & congenital Ventricular Aneurysms (CVA).
 CVA shows no midline thoraco-abdominal defects.
 Acquired forms >> secondary to a myocardial damage (myocardial
infarction, myocarditis, cardiomyopathy, trauma, tuberculosis, connective
tissue disease, and ventricular dysplasia)

17. DD of CVOs

20. Thrombosed pseudoaneurysm

21. Pseudoaneurysm (S/P myocardial
rupture)

22. Pseudoaneurysm (S/P myocardial
rupture)

23. Pseudoaneurysm (S/P myocardial
rupture)

24. Pseudoaneurysm (S/P myocardial
rupture)

25. True aneurysms

27. Another case

28. Pseudo-aneurysm of the basal to mid inferior wall that has ruptured resulting in
pericardial effusion, with a hematoma inside.

29. Pseudo-aneurysm of the basal to mid inferior wall that has ruptured resulting in
pericardial effusion, with a hematoma inside.

32. Another case

34. Another ? case

41.  Answer is diverticulum

42. ANOTHER CASE

44. ANOTHER CASE

46. ANOTHER CASE

48. EGE shows thrombus

49. LGE shows fibrosis

50. Another case

51. Aneurysmal IVS

52. Thank U
GIPRIANO@YAHOO.COM
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