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Corresponding author: Dr Leonardo E. Saavedra, Centro Cardiovascular Regional ASCARDIO, Prolongación Carrera 17, La Feria, 3002 Barquisimeto, Lara, Venezuela. Tel.: +58-251-2522592; fax: +58-251-2518398.
An asymptomatic 30-year-old high-endurance male athlete came to our outpatient clinic
in Barquisimeto, Venezuela, for a general cardiovascular examination. He had no personal
or family history of heart disease or sudden cardiac death. His physical examination
was unremarkable and resting electrocardiogram showed sinus bradycardia, left ventricular
hypertrophy, and nonspecific repolarization changes (Supplemental Fig. S1). This prompted a transthoracic echocardiogram that showed an “aberrant” papillary
muscle with insertions at the left ventricular apex and hypokinesis of the midapical
lateral wall (Fig. 1A; see Videos 1 and 2, view videos online). A computed tomography (CT) coronary angiogram revealed normal
origin and course of coronary arteries but an accessory left ventricular chamber (Fig. 1B). Cardiac magnetic resonance (MR) evaluation showed the presence of a muscular band
creating what appeared to be a second ventricular chamber with reduced wall thickness
and hypokinesis consistent with a left ventricular outpouching (LVO) (Fig. 1C; see Video 3, view video online).
Figure 1(A) Apical 4-chamber and rotated apical 2-chamber transthoracic views shows a thick
muscle bundle from the midventricular wall to the apex (arrow). (B) Cardiac computed tomography shows an “accessory” left ventricular cavity. Coronary
arteries were normal (not shown). (C) Cardiac magnetic resonance 4-chamber equivalent shows distorted left ventricle (LV)
contour and “accessory chamber” appearance. LVO, left ventricular outpouching; RV,
right ventricle.
Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European Society of Cardiology.
, view videos online). A computed tomography (CT) coronary angiogram revealed normal
origin and course of coronary arteries but an accessory left ventricular chamber (Fig. 1B). Cardiac magnetic resonance (MR) evaluation showed the presence of a muscular band
creating what appeared to be a second ventricular chamber with reduced wall thickness
and hypokinesis consistent with a left ventricular outpouching (LVO) (Fig. 1C; see Video 3 
