Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816

Background: Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. Methods: MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. Results: Weidentified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1 +/- 27 (LVA) and 29.7 +/- 27.6 years (LVD; p = 0.05). 48.9% were male. LVA was larger (38.7 +/- 22.5 mm versus 31.4 +/- 21.2 mm; p = 0.002) and frequently found in submitral location (33% versus 4.9%; p < 0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p b 0.001). LVD was often associated with cardiac (34.2% versus 11%; p < 0.001) or extracardiac anomalies (32.7% versus 3%; p < 0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p = 0.01), the incidences of rupture (4% versus 4.5%; p = 0.9), syncope (8.3% versus 5.1%; p = 0.1), and embolic events (4.9% versus 3.6%; p = 0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3 +/- 43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p= 0.05) at amedian age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p = 0.01), and rupture in the LVD-group (75.0% versus 27.3%; p = 0.04). Conclusions: LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up. (C) 2015 Elsevier Ireland Ltd. All rights reserved.