Single-Stage Repair of Left Ventricular Diverticulum with Ventricular Septal Defect Closure: A Video Illustration

Congenital diverticulum of the ventricle is a rare cardiac malformation and is usually associated with other congenital abnormalities, including intracardiac, midline thoracic, diaphragmatic, and anterior abdominal wall defects, first described by Cantrell, Haller and Ravitch (1). In this video, the authors describe a single-stage repair of an apical left ventricular diverticulum with ventricular septal defect closure in an infant.

Case Presentation

A 10-month-old infant presented with features of congestive cardiac failure and a pulsatile abdominal mass since birth. Transthoracic echocardiography and contrast-enhanced computed tomography (CT) scans revealed an apical congenital left ventricular diverticulum associated with a large perimembranous ventricular septal defect. The diverticulum extended inferiorly up to the umbilicus, forming the contents of the umbilical hernia along with bowel loops. A single-stage repair of the left ventricular diverticulum excision with ventricular septal defect closure was planned. Umbilical hernia repair was performed by the pediatric surgical team in the same setting. The patient had an uneventful postoperative course with a normal echocardiography at the routine six-month follow-up.

Discussion and Conclusion

A single-stage repair with a favorable outcome is feasible with a multidisciplinary team in an experienced center, avoiding multiple surgeries and allowing for the early restoration of the left ventricular function with complete intracardiac repair. A novel subxiphoid approach for the excision of a congenital apical left ventricular diverticulum with staged ventricular septal defect closure in an infant with pentalogy of Cantrell has also been previously described at the authors’ institution (2).

References

1. Cantrell JR, Haller JA, Ravitch MM. A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart. Surg Gynecol Obstet. 1958 Nov 1;107(5):602-14.
2. Goja S, Kumar Chaudhary S, Reddy P. A Novel Subxiphoid Approach of Left Ventricular Apical Diverticulum Excision: A Video Illustration. May 2025. doi:10.25373/ctsnet.29110031

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