Case report:
After an unsuccessful percutaneous intervention to close the ventricular
diverticulum, the patient was admitted to our clinic. The history
obtained from his family revealed that he was referred to a pediatric
cardiologist in his hometown with the complaint of a pulsating mass in
his abdomen before his admission to our department. ECG, 24h Holter
monitor, and abdominal USG were performed for further investigation. ECG
and 24-Holter monitoring were found to be normal. Abdominal USG revealed
a 6mm wide and 20 mm long pulsatile lesion and a 12mm wide umbilical
herniation. He presented to our clinic after an unsuccessful attempt of
diverticulum closure with an endovascular plug. The combination of
umbilical herniation and left ventricular diverticulum led to a probable
diagnosis of Cantrell’s Pentalogy. Figure 1 shows the preoperative
angiographic view of the left ventricular diverticulum.
The patient underwent corrective surgery at six years of age. A
midsternal incision and median sternotomy were made. The lower third of
the sternum was absent, and the anterior pericardium was observed as a
thin membrane. The pericardium was opened, and a piece was reserved to
be used as a pledget. The apical left ventricle diverticulum with a
length of 8 cm was observed, and the incision was extended to the
umbilicus. The diverticulum was separated from the surrounding fascia.
Aortic and two-stage venous cannulations were performed to initiate the
cardiopulmonary bypass. The diastolic arrest was provided with a
cross-clamp to ascending aorta using antegrade tepid blood cardioplegia.
The diverticulum was excised, and the three layers (endocardium,
myocardium, and epicardium) were observed. Figure 2 shows the operative
view of the diverticulum before excision and three layers of the
diverticulum on both sides. The excised diverticulum was sent to
pathology for examination, and the ventricular side of the defect was
closed with 4-0 prolene sutures and pericardial pledgetes. After gradual
reduction, the cardiopulmonary bypass was ended, and the heart was
decannulated. Wires for the temporary ventricular pacemaker and the
drainage tubes were placed. After primary closure of the umbilical
defect and the anterior abdominal wall, sternotomy and the abdominal
incision were closed.