Fetal Right Ventricular Diverticulum with Pericardial Effusion: To Drain or Not To Drain?

Congenital right ventricular diverticulum is a rare form of congenital heart disease often associated with pericardial effusion or other cardiac malformations. The optimal management of this disease has not yet been established. Reviewing the literature, the most common approach is excision or pericardial effusion drainage during fetal or post-natal life, based on morphology and hemodynamic pattern of diverticulum. Pericardiocentesis is recommended for decompressing the fetal thorax, avoiding the risk of pulmonary hypoplasia and allowing lung maturation, but especially in fetal life, it carries a very high risk of abort or fetal damage. We report a case in which, considering the asymptomatic clinical setting and the stability of the hemodynamic conditions, the treatment successfully chosen was a long-term watchful waiting. Our experience confirmed that, in asymptomatic patients, conservative management may be a reasonable option as the pericardial effusion rounding the diverticulum may progressively disappear not requiring any therapeutic intervention.