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.