Poster No. 113 Case report: the challenges in diagnosing congenital double-chambered left ventricle in adults

Double-chambered left ventricle is a congenital condition that rarely presents in adulthood. This case report illustrates the common cardiac imaging modalities and presents the diagnostic challenges.

Clinical history and cardiac imaging was obtained using electronic systems and E-letters. Literature search was performed using PubMed with keywords including double-chambered ventricle and congenital heart disease.

A 76-year-old female presented with breathlessness, her transthoracic echocardiogram (TTE) showed severely impaired bi-ventricular function. An incidental echogenic structure was identified and treated initially as a left ventricular (LV) thrombus. Follow-up cardiac magnetic resonance (CMR) with perfusion confirmed the LV apical mass, but thought was more in keeping with a tumour. Further investigations with a gated cardiac Computerised Tomography (CT) and a review of the original CMR demonstrated appearances that were consistent with a developmental congenital double-chambered left ventricle rather than a false aneurysm or thrombus. This was confirmed on repeat CMR and with enhancement and transoesophageal echocardiogram (TOE) on 3D reconstruction. A discussion between Cardiologist and Cardiac Surgeons concluded that she is unlikely to benefit from any surgical intervention. The patient has since had significant improvement in LV function with medical therapy.

This report highlights an interesting case where congenital double-chambered left ventricle can act as a mimic for left ventricular thrombus or tumour. Current cardiac imaging modalities can be used in combination to achieve the diagnosis. It also demonstrates that pharmacological therapy alone is an adequate treatment to manage the symptoms of severely impaired bi-ventricular function in these patients.