PMC4834181_01
Four-chamber view in a transthoracic echocardiogram showing enlargement of
the left ventricle (LV) (The LV apical structure was unclear in this view)
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Since the LV apex was not clear in the four-chamber view of the echocardiographic evaluation (Figure 1) and to study the kinetic features of the congenital malformation and its morphological characteristics, we performed contrast-enhanced cardiac MRI, using a 1.5 T whole-body scanner (Avanto, Siemens, Erlangen).
Cine cardiac magnetic resonance imaging (MRI) image in a four-chamber view
shows bulging of the interventricular septum (IVS) toward the right ventricle (white
arrow) and invagination of fatty material (black arrow)
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It also indicated invagination of fatty material and elongation of a normally functioning right ventricle around the deficient LV apex (Figure 2).
A T1-weighted image shows bright tissue replaced in the left ventricle (LV)
apical position (white arrow), which could suggest the presence of fat replacement
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Black-blood T1-weighted sequences with and without fat saturation on short-axis and long-axis views were performed to assess alterations of the myocardial signals (Figure 3).
A late gadolinium enhancement (LGE) image performed 10 minutes after the
contrast media injection showed no intramyocardial hyperenhancement area but indicated
the presence of myocardial tissue in the out pouching; this confirmed the congenital
nature of the diverticulum
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TR = 600 ms; TE = 3.4 ms; FA = 25 ; acquisition matrix = 156 x 256; FOV = 320 x 400 mm; slice number = 10 slices; and cardiac phase = mid-diastole. There were no signs of fibrosis or necrosis tissue presenting in the circumferential wall of the diverticulum showing by the delayed enhancement images (Figure 4).