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Case report
Interventricular septal diverticulum and rheumatic mitral valve disease identified and managed concurrently in middle age
  1. Joseph Barker,
  2. Gary Zealand and
  3. Miles Williams
  1. Cardiology, Hawkes Bay Hospital, Hastings, New Zealand
  1. Correspondence to Dr Joseph Barker; joseph.barker{at}


Cardiac diverticula represent an extremely rare but serious cause of cardiac morbidity and mortality. They can result to arrhythmia, sudden cardiac death and ventricular dysfunction but may have no pathological implications. Here is a case of a 60-year-old Maori farmer with both rheumatic mitral valve disease and left ventricular (LV) septal diverticulum. The requirement for mitral valve replacement raised the complex decision of whether to undergo concurrent diverticulum repair. The haemodynamic significance of the diverticulum was impossible to ascertain, although we could not in good conscience leave such a large diverticulum with potential to influence further systolic deterioration. Three months after the procedures, the patient developed severe tricuspid regurgitation which is a first reported association postseptal diverticulum repair. The case highlights that careful consideration is required in repairing LV septal diverticula and an emphasis should be placed on complications and the requirement for repeat surgery during the consent process.

  • valvar diseases
  • cardiothoracic surgery

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  • Contributors JB was the primary author of the article with support from GZ and MW. GZ was primarily responsible for image acquisition and interpretation with MW. MW made substantial contributions to the paper conception as with GZ critically revising intellectual content. All authors approved the final works and agree to be accountable for all aspects of the works accuracy and integrity.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.