EP09.85: Prenatal diagnosis of left ventricular aneurysm in a dichorionic diamniotic twin and its management: a case report

Ventricular aneurysm (VA) is rare with a reported incidence of 0.5 per 100,000 live births and the differential diagnoses are diverticulum, pseudoaneurysm, congenital cysts and clefts. Features of VA are abnormal four-chamber view on fetal echocardiogram, arrhythmia, pericardial effusion and hydrops. Though VA occur isolated and remain asymptomatic, complications such as tachyarrhythmias, systemic embolism, spontaneous rupture, severe valvular regurgitation and sudden death can occur. Here we present a dichorionic diamniotic (DCDA) twin gestation wherein one fetus was diagnosed with left ventricular aneurysm (LVA). 24-year-old primigravida presented for targeted anomaly scan (USG) at 19 weeks. USG revealed DCDA twins with fetus A showing a thin-walled outpouching measuring 12 x 8mm with a wide neck at the apex of left ventricular wall with no demonstrable contraction during systole. Fetal arrhythmia was noted. Colour Doppler showed low velocity turbulent flow into the pouch with no features of hemodynamic compromise. Diagnosis of LVA was made. Fetus B was normal. The family was counselled regarding the prognosis and implications. Multidisciplinary team including neonatologist, pediatric cardiologist and geneticist were involved. The family opted for selective reduction of fetus A. Post reduction, pregnancy continued with close monitoring and she delivered a term live female baby of weight 2.39kg with good APGAR scores. Postnatal evaluation of fetus B was normal. Isolated congenital LVAs are more common. Complications include spontaneous rupture, arrhythmia, congestive heart failure, thromboembolism, mass effect resulting in underdevelopment of the lungs and fatal cardiovascular complications. The prognosis for congenital ventricular aneurysm is related to size, location, degree of mitral valve involvement, and ventricular arrhythmias. Treatment options of symptomatic LVA requires surgical correction, thromboembolism prevention with anticoagulants, and treatment of any associated symptoms such as arrhythmias or CHF.