Abstract
BACKGROUND: Congenital left ventricular diverticulum (LVD) is a rare cardiac malformation that may cause catastrophic complications, such as ventricular tachycardia (VT). The surgical indication for LVD remains controversial. CASE SUMMARY: A 31-year-old man was diagnosed with LVD through multimodality imaging that involved electrocardiogram, transesophageal echocardiography, cardiac computed tomography angiography, and magnetic resonance imaging. Intracardiac echocardiography and electrophysiological mapping confirmed the arrhythmia originating inside the diverticular cavity. With ineffective conservative treatment, surgery became the preferable option. The surgical approach was guided by preoperative three-dimensional printed reconstruction. The procedure involved diverticulum patch repair combined with radiofrequency ablation and, unexpectedly, mitral valve replacement. The patient recovered well. DISCUSSION: VT originating from an LVD is a rare and catastrophic complication, with multimodal imaging essential for diagnosis. Surgical repair and radiofrequency ablation are effective treatments for LVD complicated by arrhythmia. TAKE-HOME MESSAGE: Treatment with medication alone may be insufficient for LVD with VT, and surgery is recommended.