Subvalvular and Apical Left Ventricular Aneurysms in the Bantu as a Source of Systemic Emboli

Abstract

Systemic emboli originating from apical and subvalvular left ventricular aneurysms are described in two Bantu patients. The infrequency of embolism from these aneurysms is probably related to the fact that such aneurysms usually have small ostia. The pertinent literature is reviewed and the similarity between these aneurysms, congenital epicardial cysts, and fibrous diverticula is discussed. It is postulated that these conditions share a common etiology, namely, a congenital weakness in the left ventricular wall in the form of a persistent primitive endothelial-lined channel. The high pressure in the left ventricle converts these channels into fibrous aneurysms with ostia lined by endocardium at the two sites where the ventricular wall is thinnest, namely, the apical and subvalvular areas.