Overview
Congenital cardiac diverticulum refers to an abnormal pouch or sac protruding from the wall of the heart, often involving the left ventricle or right ventricle, which can lead to hemodynamic disturbances and require surgical intervention 1.Diagnosis
Echocardiography is essential for initial diagnosis, providing detailed images of the diverticulum's location and size 1.
Cardiac MRI or CT angiography may be used for further characterization and assessment of complications 1.
Hemodynamic instability and associated symptoms like heart failure warrant urgent evaluation 1.Management
Surgical repair is typically indicated for symptomatic diverticula or those causing significant hemodynamic compromise 1.
In critically ill pediatric patients requiring ECMO, therapeutic plasma exchange (TPE) may be considered for managing thrombocytopenia-associated multiple organ failure (TAMOF) as an adjunctive therapy 1.
Anticoagulation with systemic bivalirudin is recommended during TPE procedures 1.
Replacement fluid typically consists of plasma, administered at volumes around 168 mL/kg per session 1.Special Populations
Pediatrics: Critically ill pediatric patients with congenital cardiac diverticula may require ECMO support, with TPE considered for managing TAMOF 1.
No specific recommendations provided for pregnancy, elderly, or comorbid conditions in the given abstracts 1.Key Recommendations
Perform echocardiography as the primary diagnostic tool for congenital cardiac diverticulum 1.
Consider surgical intervention for symptomatic diverticula or those causing hemodynamic instability 1 (Evidence: Expert opinion).
In pediatric patients on ECMO, therapeutic plasma exchange may be utilized to manage TAMOF, using plasma as replacement fluid and systemic bivalirudin for anticoagulation 1 (Evidence: Weak).References
1 Labarinas S, Norbisrath K, Nnaemeka I, Bai Y, Tint H, Johnson D et al.. Plasma Exchange in the Setting of Immune-Mediated Multiple Organ Failure in the Cardiac ICU During ECMO: A Case Series. Journal of clinical apheresis 2025. link