Diverticulum, or not Diverticulum, That Is the Question! Discussing About a Case of Left Ventricular Outpouching Associated With Bicuspid Aortic Valve Assessed by Cardiac Magnetic Resonance

Congenital left ventricular outpouchings (LVOs) are infrequent myocardial malformations,comprising various overlapping abnormalities, whose characterization is often intricate in clinical practice using traditional non-invasive techniques. We describe a rare case of LVO associated with bicuspid aortic valve incidentally found in an asymptomatic adult patient. The LVO waslocated at basal level of the chamber, crescent-shaped with its largest diameter in short-axisview and presented a thin hypo-contractile wall without hyperintense areas on late gadoliniumenhanced (LGE) images. This description corresponds to an overlap between usual definitionof aneurism, fibrous and muscular diverticulum. The LVO was evaluated according with aclassification recently proposed by Malakan Rad. In this case ventricular geometry was respected,wall thickness was reduced and wall motion compromised therefore corresponding to a smallIIc-type, which is considered having the poorest prognosis. Furthermore, the association withbicuspid aortic valve is very unusual. The patient refused surgery and preferred follow-up.