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J Thorac Cardiovasc Surg 2006;132:1087-1091
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Congenital cardiac diverticulum in the subaortic valve area

^a Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
^b Department of Cardiothoracic Surgery, The Second Teaching Hospital of Shanxi Medical University, Taiyuan, China.

Received for publication June 23, 2006; accepted for publication August 11, 2006.

^_* Address for reprints: Zongquan Sun, MD, Department of Cardiovascular Surgery, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 P R China (Email: olympicschina{at}163.com).

OBJECTIVE: We report and review the clinical characteristics and operative techniques of the rare malformation of congenital cardiac diverticulum in the subaortic valve area.

METHODS: Four male patients with congenital ventricular fibrous diverticula in the subaortic valve area are reported.

RESULTS: The patients' ages ranged from 4 to 47 years (mean 39 years). The first case was complicated by rupture, pseudoaneurysm formation, and a hemopericardium, and was only diagnosed on the third surgical exploration. The second case was associated with endocarditis involving both aortic and mitral regurgitation. The diverticulum was suspected on 2-dimensional transthoracic echocardiography and confirmed at surgery. In the third case, the subaortic diverticulum was associated with a rupture of the left cusp of the aortic valve with severe regurgitation. In the fourth case, the diverticulum was located between the aortic and mitral valves with a diameter of approximately 30 mm and was associated with multiple perforations of an aortic valve leaflet and severe regurgitation. There were no other congenital thoracoabdominal or cardiac anomalies. At a mean follow-up of 1 year, all patients were well.

CONCLUSIONS: Congenital cardiac diverticulum in the subaortic valve area is a rare anomaly. Transthoracic echocardiography and transesophageal echocardiography are reliable tools for the diagnosis and follow-up. Isolated congenital cardiac diverticula in the subaortic valve area tend to involve a benign clinical process, but may be complicated by spontaneous rupture or endocarditis. Surgical resection is performed when complications require surgical therapy.