OP-14 Fetal right ventricular diverticulum a case report

Aim

We report the case of 27 years old age Turkish lady G2 P1 at 20 weeks of gestations, double test was normal, attended for routine prenatal ultrasound screening a four chamber ultrasound of the heart with right ventricular diverticulum associated with pericardial effusion.

Case

A 27 years old age woman at 20 weeks of gestation, came for routine second trimester ultrasound screening. Ultrasound revealed four chambers of the heart with right ventricular outpouching (right ventricular diverticula or aneurysm) associated with pericardial effusion, no other anomalies. She was explained about the ultrasound findings and referred to pediatrics cardiology, fetal cardiac echo was done, confirmed the ultrasound findings and the diagnosis of fetal right ventricular diverticulum with pericardial effusion with no other cardiac malformations. She was followed up by ultrasound at 22 weeks of gestations, which revealed same findings but the pericardial effusion increased. Follow up ultrasound at 24 weeks of gestations the fetus was intrauterine death.

Discussion

By reviewing literature the overall prenatal prognosis of ventricular diverticula is favorable even if associated with pericardial effusion, hence conservative management may be a reasonable option, unless there is risk of impending rupture, cardiac temponade or significant lung compression and subsequently pulmonary hypoplasia. Our case was with right ventricular diverticulum and pericardial effusion and no other cardiac malformations and the choice of conservative management was opted but the fetus died at 24 weeks of gestation. Among the therapeutic options fetal pericardiocentesis to decompress the fetal thorax to allow lung expansion and reduction of systemic venous pressure leading to reduction in the risk of pulmonary hypoplasia but the risk is considered too high especially in isolated ventricular diverticulum with pericardial effusion as pulmonary hypoplasia usually resolve with corticosteroid therapy and pericardial effusion disappears progressively in most of the cases.

Conclusion

The prognosis is good in isolated cases. The 10 years survival rate for the patients with ventricular diverticula is approximately 80% while the 4 years survival rate for patients with congenital ventricular anuerysm is approximately 30%. However complications include rupture, arrhythmia, thrombus formation, heart failure and infective endocarditis, therefore, monitoring is required.

Keywords

Diverticulum, fetal heart, right venticle

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