Dynamic 3D Simulation Modeling for Surgical Management of Giant Congenital Left Ventricular Diverticulum: A Case Report

Background: Congenital left ventricular diverticulum is an uncommon cardiac malformation that may present with chest pain, ventricular arrhythmia, thromboembolism, or rupture risk depending on lesion morphology and wall composition. Case description: We report an adolescent male with chest pain and frequent premature ventricular complexes who was found to have a giant apical left ventricular diverticulum with marked wall thinning and regional hypokinesia. Multimodality imaging, including transthoracic echocardiography, computed tomography, cardiac magnetic resonance, and myocardial perfusion/metabolic assessment, supported the diagnosis of a fibrous diverticulum and helped exclude ischemic myocardial injury. To refine operative planning, patient-specific dynamic three-dimensional (3D) simulation modeling was performed preoperatively to delineate the diverticular neck, estimate the residual ventricular cavity, and define the spatial relationship between the lesion and adjacent coronary branches. Surgical repair was completed under cardiopulmonary bypass by intracavitary exclusion of the neck with a bovine pericardial patch, followed by resection of the diverticular sac and reinforced sandwich closure of the residual ventricular wall. Pathology confirmed a fibrous diverticulum. The postoperative course was uneventful, and follow-up demonstrated relief of symptoms without documented recurrent arrhythmia. Conclusion: This case highlights the adjunctive value of dynamic 3D simulation modeling in complex ventricular reconstructive surgery by improving spatial understanding, facilitating individualized operative planning, and supporting preservation of residual ventricular function.