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False image of left ventricular diverticulum caused by local hypertrophy

Publication at First Faculty of Medicine |
2009

Abstract

A 51-year-old male was referred to our institution for catheter ablation of permanent atrial fibrillation. A left atrial catheter ablation procedure was performed, utilizing electroanatomical CARTO mapping.

During follow-up, symptoms of exertional angina pectoris persisted while in stable sinus rhythm. Diagnostic cardiac catheterization was performed.

Ventriculography revealed the presence of an aneurysm-like pouch on the diaphragmatic wall with preserved contractions. Further examination with magnetic resonance revealed local hypertrophy (20mm during diastolic phase) of posterolateral segments in the middle and apical third of the left ventricle including posterolateral papillary muscle.

The basal portion of this region showed no hypertrophy, and this led to the subsequent false image of diverticulum. Our case showed the importance and superiority of noninvasive imaging techniques for improved diagnosis in this rare form of hypertrophic cardiomyopathy.