Introduction
Cardiac diverticula is a highly infrequent inherited deformity with only 0.05 % of all inherited cardiovascular deformities. A diverticulum refers to a tiny protrusion from an organ that forms a small sac or pouch. The heart is made up of four chambers, two upper chambers, namely the left and right atrium, and two lower chambers, namely, the left and right ventricle.
When the left ventricle or when the right ventricle forms an abnormal sac or pouch (diverticula), it is called cardiac diverticula or a cardiac diverticulum. Such diverticula can either be fibrous or muscular in nature. When it is fibrous in nature, it is referred to as an aneurysm and is seen to be secluded in the body. Most patients with fibrous cardiac diverticula show no symptoms. The muscular diverticula has muscular edges extending into the heart. This type of diverticula is usually seen in infants. Surgical correction is advisable only after the correct diagnosis of the exact kind of cardiac diverticula is made.
The majority of the time, a cardiac diverticulum is asymptomatic, but it can lead to several complications such as arrhythmia and infection of the heart muscles. It can be diagnosed by several procedures, such as an ECG (electrocardiograph) or MRI (magnetic resonance imaging) of the heart. A case of cardiac diverticula is generally associated with other cardiovascular deformities such as defects in the heart’s septa or walls, closed or open orifices in the heart’s structure, etc.
How to Diagnose Cardiac Diverticula?
Cardiac diverticula are majorly found in infants and newborns. It is rarely found in adults. Diagnosis of cardiac diverticula is made through various procedures and tests. The most customary position of the diverticula is the left ventricular wall. This is because of the fact that the left ventricular wall is freely positioned. It has also been reported that cardiac diverticula can be present in other heart chambers as well.
Physical examination of the body, as well as clinical case history, is essential. With the help of the latest advancements in the field of radiology, such as computed-tomographic angiography, echocardiogram, catheter angiography, and MRI of the heart, it is possible to have an accurate picture of the underlying cardiac deformity and its extent. There is no distinct sign, laboratory investigation, or pathognomic reading that clearly states the presence of cardiac diverticula. Alternatively, changes in standard radiographic patterns of the heart can give a slight idea of the conditions.
Some uncommon radiographic alterations of the heart include increased heart size called cardiomegaly, the border of the heart presenting a deviated septum, and an unusual overall contour of the heart. Doppler sonography also has the potential to come up with some supplementary particulars regarding the functioning of the heart during the presence of diverticula.
What Are the Signs and Symptoms of a Cardiac Diverticula?
Cardiac diverticula are frequently not very prominent or evident in their manifestations. But it is always linked with simultaneous underlying conditions such as irregular heartbeats called arrhythmia, rupture of the cardiac muscles, heart failure, etc. Cardiac diverticula do not have many clinical features. Still, some of them include chest pain, palpitations, and shortness of breath called dyspnea. Arrhythmia, if present, is generally associated with ventricular contractions that are premature in nature and may possibly lead to occasional cardiac failure. Chest pain that has no definite characteristic is also a clinical sign. Heart sounds or heart murmurs can possibly be indicative of the presence of diverticula. It should be kept in mind that there has not been established any direct or straightforward connection between cardiac diverticula and precise heart murmurs.
What Causes Cardiac Diverticula?
The reason for the formation of cardiac diverticula is yet unknown. Factors such as hemodynamics can play a role in the formation of cardiac diverticula. Some of the examples of hemodynamic factors include variation in blood flow between the heart to the lungs and vice versa, low cardiac output, obstruction in the walls of the heart, etc.
During the fourth year of embryonic development, pouches of the ventricular wall that are yet immature and not fully formed, begin to enlarge the volume of the ventricular cavity. If this process does not become successful, a deformity or a diverticula gets introduced into the fetus. This may be one of the causes of cardiac diverticula, but this cause too has to be studied, just like the other proposed causes for the same. Auxiliary reasons for the formation of cardiac diverticula can be diseases of the connective tissue with a history of cardiovascular issues like coronary artery disease. This is typically found in adults.
Can Cardiac Diverticula Be Treated?
The prevalence of cardiac diverticula is less than 0.1 % of the inherited cardiovascular conditions. Due to this, there has been an absence of a wide range of treatment modalities present as of today. Nevertheless, studies and research have been going on for a more direct and well-established treatment plan for the same. Currently, surgical intervention is the usual way to treat cardiac diverticula. It is an invasive line of action but has good results. It has also been suggested that surgical treatment of cardiac diverticula holds the potential to cancel other cardiovascular risks such as the deviated septum, arrhythmia, or any future diverticula in other chambers of the heart. On the other hand, it is also believed that in case a cardiac diverticulum is asymptomatic; it does not call for any surgical treatment and can be left alone.
Conclusion
Congenital cardiac diverticula or diverticulum is a rare deformity of the heart’s structure. Intensive CT and MRI of the heart prove to be secure and powerful tools for the detection of cardiac diverticula. Asymptomatic cardiac diverticula can preferably be left alone. Post-surgical treatment, the patient must follow up with their doctors. With surgical treatments, the therapeutic effect on the heart is good, and studies show a possibility to return the heart to its regular cardiac functions.
