Left ventricular aneurysm in the fetus: a diagnosis with a mixed prognosis

Matiasand colleagues 1 describe 3 cases of left ventricular aneurysm detected by prenatal echocardiography.Prior to this series, a mere 9 cases had been published. 2~7 As such, this report must be considered a substantial addition to the literature on this topic.At the same time as the cases described by Matias et al.' can be said to further our knowledge of this rare condition, however, they also serve to confound our understanding of it.Insofar as their outcome was uniformly poor, the ultimate fate of these 3 fetuses differed substantially from the majority of the previously reported experience.Of the 9 previously described cases, 6 survived to birth and were asymptomatic postnatally, 2 aborted spontaneously, and 1 pregnancy was terminated after the identification of fetal hydrops.By opening our eyes more fully to the breadth and balance of the prognostic spectrum for this condition, this report simultaneously compels us to acknowledge how little we know about it.What are the causes?What is the natural history?Perhaps most important, are there historical, morphologic, or physiologic factors that can help us predict which fetuses will do well and which will do poorly?The value of this report lies not simply in its addition of 3 new cases to the existing literature, and its challenge to us to strive for improved understanding of fetal left ventricular aneurysm, but more so in the unprecedented extent to which the physiology of this condition is detailed.Matias et al. provide us with important new information about the potential functional disturbances that