A surgical case of right ventricular outpouching

Abstract

Outpouching of the heart ventricles, especially of the right ventricle, is rare. Here, we report the case of a 60-year-old male, referred to our institution with an outpouched structure at the right ventricular apex. The patient had no cardiac events. The outpouching was detected incidentally on computed tomography. The structure communicated with the right ventricle through a narrow pedicle. It did not contract, but showed dyskinetic movement with a thin wall. We safely resected it using off-pump coronary bypass apparatuses without cardiopulmonary bypass. Histopathological examination revealed muscular tissues only on the base of the structure, and certain parts of the wall were extremely thin. The treatment of ventricular outpouching, especially of the right ventricle, is controversial. The surgical indications could be decided by comparing the actual risk of rupture with that of surgery if we could accumulate the data from more cases.

Learning objectives

• 1.
  The terminology of heart ventricular outpouched structures is obscure and the structure presented in our patient may be termed a diverticulum, aneurysm, pseudoaneurysm, epicardial cyst, or an outpouching.
• 2.
  Some right ventricular outpouchings can be resected safely using off-pump coronary bypass apparatuses without cardiopulmonary bypass.
• 3.
  The surgical indications for right ventricular outpouching refer to those for left ventricular outpouching. More data are expected in the future.