Double Chambered Left Ventricle in a 56-YOF scheduled for transcatheter aortic valve implantation (TAVI) planning incidentally detected by CTA

DCLV is characterized by the presence of two LV-chambers, oriented in parallel and must be distinguished from a LV-diverticulum by the presence of an additional contractile septum.A 56-years-old female with severe aortic stenosis was referred to cardiac computed tomography angiography (CTA) for planning of transcatheter aortic valve implantation (TAVI).She had undergone surgical closure of a membranous ventricular septal defect (VSD), and pulmonary banding with debanding 8 years later.Echocardiography reported muscular VSDs with hypertrabeculations ("swisscheese"-pattern) and almost-total closure with possible minimal residual shunt.Cardiac CTA showed an unusual left ventricle (LV) consisting of two chambers with apexes oriented parallel anteriorly oblique (Fig. 1), and excessive LV-hypertrabeculation apical and midventricular septal (mid panel) mimicking a muscular VSD midseptal.TAVI was deferred to avoid the risk of wire trapping and LV-perforation.She underwent mechanical aortic valve replacement (21 mm On-X™ prosthesis) and patch repair of the residual pulmonary stenosis.The small residual VSD reported by echocardiography could not be located intraprocedural. 1 year follow-up was uneventful.Double-chambered left ventricle (DCLV) is extremely rare (estimated prevalence 0.04-0.42%)-although the exact prevalence is unknown and most commonly involving the right ventricle, while the incidence left is even scarcer with only few cases reported worldwide.