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Fakhri G, Obeid M, El Rassi I, Tabbakh A, Bitar F, Alameddine M, Arabi M. Large congenital left atrial wall aneurysm: An updated and comprehensive review of the literature. Echocardiography 2020; 37:965-970. [PMID: 32428351 DOI: 10.1111/echo.14687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/29/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital left atrial wall aneurysms are rare abnormalities that arise from a developmental weakness in the muscular wall. It may be misdiagnosed or go undetected and the delay in diagnosis can lead to catastrophic consequences. CASE PRESENTATION An updated and comprehensive review of the literature was performed for all patients with this abnormality under the age of 18. A total of 15 cases including ours are presented in this article. We present a 10-month-old boy who was referred to our center for cardiomegaly. Workup revealed a large atrial wall aneurysm that was successfully corrected with surgery. CONCLUSION Historically, left atrial aneurysms were uncommon in the absence of valvular heart disease or other cardiac conditions. Congenital aneurysms are rare phenomenon because they arise without an acquired cardiac disease and surgical correction is crucial for survival.
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Affiliation(s)
- Ghina Fakhri
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mounir Obeid
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anas Tabbakh
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Alameddine
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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2
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Abstract
A congenital aneurysm of the left atrial wall (ALAW) is a rare defect resulting from dysplasia and degeneration of myocardial cells in embryogenesis. We report a case of a 50-year-old female with ALAW, and review 16 previously reported cases and summarize the clinical features, imaging data, and the operations used to treat this rare disease.
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Affiliation(s)
- Yuyan Cai
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hong Tang
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ke Dian
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, Chengdu, China
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3
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Moraes CR, Tompson G, Cavalcanti I, Ar-Ruda M, Victor E. Congenital Aneurysm of the Left Atrium. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857447801200111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Carlos Roberto Moraes
- Department of Surgery (Division of Thoracic Surgery), Federal University of Pernambuco Medical School and Department of Medicine (Division of Cardiology), Federal University of Pernambuco Medical School, Recife, Brazil
| | - Gilvan Tompson
- Department of Surgery (Division of Thoracic Surgery), Federal University of Pernambuco Medical School and Department of Medicine (Division of Cardiology), Federal University of Pernambuco Medical School, Recife, Brazil
| | - Ivan Cavalcanti
- Department of Surgery (Division of Thoracic Surgery), Federal University of Pernambuco Medical School and Department of Medicine (Division of Cardiology), Federal University of Pernambuco Medical School, Recife, Brazil
| | - Mauro Ar-Ruda
- Department of Surgery (Division of Thoracic Surgery), Federal University of Pernambuco Medical School and Department of Medicine (Division of Cardiology), Federal University of Pernambuco Medical School, Recife, Brazil
| | - Edgar Victor
- Department of Surgery (Division of Thoracic Surgery), Federal University of Pernambuco Medical School and Department of Medicine (Division of Cardiology), Federal University of Pernambuco Medical School, Recife, Brazil
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Abstract
Aneurysms of the left atrium are rare abnormalities. They can be congenital or acquired. Whereas a true congenital aneurysm presents as isolated pathology, inflammatory or degenerative processes involving the endocardium are associated with the acquired type. The clinical records of 2 patients with the diagnosis of left atrial aneurysm were reviewed, along with the surgical strategies, current literature, and patient outcomes. Because of the risk of life-threatening complications, surgery is recommended even in asymptomatic cases. Resection and mitral valvuloplasty should be the treatment of choice.
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Affiliation(s)
- J M Morales
- Driscoll Children's Hospital, Corpus Christi, Texas, USA.
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5
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Terada H, Tanaka Y, Kashima K, Sannou K, Arima T. Left atrial diverticulum associated with severe mitral regurgitation. JAPANESE CIRCULATION JOURNAL 2000; 64:474-6. [PMID: 10875742 DOI: 10.1253/jcj.64.474] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diverticulum of the atrium is a rare and controversial clinical entity, and in the present case a left atrial diverticulum was associated with severe mitral regurgitation (MR). A 68-year-old female with the diagnosis of MR was referred for further cardiac evaluation. Echocardiography revealed severe MR and an accessory cavity behind an enlarged left atrium. She underwent surgical valve replacement, but excision of the diverticulum was not done because its rupture seemed unlikely. A follow-up computed tomography performed 8 months postoperatively demonstrated disappearance of the diverticulum. The etiology of this atrial diverticulum is not clear, but the patient's MR may have played a role in its development.
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Affiliation(s)
- H Terada
- The Second Department of Internal Medicine, Kagoshima University, Japan
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6
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Otaki M. Surgical treatment of patients with cardiac cachexia. An analysis of factors affecting operative mortality. Chest 1994; 105:1347-51. [PMID: 8181317 DOI: 10.1378/chest.105.5.1347] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
During the period from 1982 to 1990, we operated on 25 patients with cardiac cachexia associated with a long history of combined mitral and tricuspid diseases. The age distribution was 44 to 68 years, with an average of 58 years. The overall operative mortality was 28 percent (7/25). However, the operative mortality differed according to various factors. Patients with preoperative nutritional support had a mortality rate of 17 percent, as compared with 57 percent for those without nutritional support (p < 0.05). The operative mortality was higher in patients with giant left atrium (39 percent vs 0 percent, p < 0.01). The postoperative cardiothoracic ratio in chest radiographs was significantly decreased by left atrial plication (91.6 percent vs 74.1 percent, p < 0.05). However, the operative mortality in patients with plication was still higher than in patients whose left atrium was left intact (67 percent vs 16 percent, p < 0.025). Advanced age, female sex, advanced tricuspid regurgitation, preoperative renal failure (serum urea nitrogen > 30 mg/dl), and hepatic failure (ascites or serum total bilirubin > 2.5 mg/dl) had no significant effects on operative mortality. The results demonstrated that preoperative nutritional support resulted in significant decreases in the incidence of postoperative respiratory failure and operative mortality. In contrast, postoperative respiratory failure occurred in a high percentage of patients without nutritional support even though left atrial plication was successfully performed.
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Affiliation(s)
- M Otaki
- Department of Cardiovascular Surgery, Osaka National Hospital, Japan
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7
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Stone KS, Brown JW, Canal D, Caldwell R, Hurwitz R, King H. Congenital aneurysm of the left atrial wall in infancy. Ann Thorac Surg 1990; 49:476-8. [PMID: 2310259 DOI: 10.1016/0003-4975(90)90262-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A 5-month-old male infant with congenital left atrial aneurysm is reported. The youngest patient previously reported was 2 1/2 years old. This case is unusual because the patient was an infant and because of the degree of mitral insufficiency and acute cardiac decompensation observed in the patient.
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Affiliation(s)
- K S Stone
- Department of Surgery, Indiana University Medical Center, Indianapolis 46223
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8
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Dusleag J, Klein W, Eber B, Gasser R, Weinrauch V, Rotman B. Noninvasive and invasive diagnosis of a huge congenital aneurysm of the left atrium: a case report. Angiology 1990; 41:139-44. [PMID: 2306006 DOI: 10.1177/000331979004100208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
An intrapericardial aneurysm of the left atrium in a twenty-eight-year old asymptomatic woman is reported. The aneurysm was diagnosed by two-dimensional echocardiography and the specific intraaneurysmatic flow pattern was described by color blood flow imaging. To the authors' knowledge such a noninvasive diagnosis of a left atrial aneurysm has never been reported in the literature before. The diagnosis was confirmed by angiocardiography. The aneurysm was successfully resected. The patient was discharged without medication and continues to do well.
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Affiliation(s)
- J Dusleag
- Division of Cardiology, University Clinic of Medicine, Graz, Austria
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9
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Pinamonti B, Alberti E, Buttignol G, Cristaldi A, Camerini F. Echocardiographic diagnosis of congenital left atrial aneurysm. Am Heart J 1986; 111:406-9. [PMID: 3946182 DOI: 10.1016/0002-8703(86)90160-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Abstract
Left atrial aneurysm is a rare condition. Only 29 cases have been reported, to our knowledge. We report 1 such case in a 24-year-old man who complained of dyspnea and arrhythmias. Diagnosis was suspected on review of chest roentgenogram and confirmed by echocardiography and cardiac catheterization. Surgical repair was achieved without complications, and preoperative symptoms disappeared completely. According to the literature, these patients are almost always asymptomatic. When present, the most common symptoms are arrhythmias, heart failure, emboli, and chest pain. This lesion is seen mainly in young adults (mean age, 23.5 years). The diagnosis should be confirmed by echocardiography, nuclear imaging, and cardiac catheterization. A review of the literature indicates that surgical repair can be accomplished with low mortality and that arrhythmias usually disappear postoperatively.
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11
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Porter BA, Bogren HG, DeMaria AN. Cor triatriatum in an adult with mitral regurgitation and massive left atrial enlargement. Cardiovasc Intervent Radiol 1983; 6:37-40. [PMID: 6221796 DOI: 10.1007/bf02552790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An unusual case of cor triatriatum in a 52-year-old woman is described in which the preoperative diagnosis was obscured by the presence of mitral valvular regurgitation and massive left atrial enlargement; such massive left atrial enlargement has not been reported before in this entity. Only the right pulmonary veins drained into the accessory chamber. The abnormal septum dividing the left atrium was demonstrated by two-dimensional but not M-mode echocardiography.
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12
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Foale RA, Gibson TC, Guyer DE, Gillam L, King ME, Weyman AE. Congenital aneurysms of the left atrium: recognition by cross-sectional echocardiography. Circulation 1982; 66:1065-9. [PMID: 7127690 DOI: 10.1161/01.cir.66.5.1065] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.
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13
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Bramlet DA, Edwards JE. Congenital aneurysm of left atrial appendage. BRITISH HEART JOURNAL 1981; 45:97-100. [PMID: 7459169 PMCID: PMC482494 DOI: 10.1136/hrt.45.1.97] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Congenital aneurysm of the left atrial appendage is a rare anomaly, usually presenting in adult life. The case reported is that of a 55-year-old man who died of cerebral embolism originating from a thrombus in a congenital aneurysm of the left atrial appendage. The cardiac silhouette 11 years previously had suggested a cardiac tumour or a pericardial cyst. As judged frm 14 published cases, the major manifestations of these aneurysms are an abnormal cardiac silhouette in the x-ray, supraventricular tachycardia, and systemic embolism. Angiocardiography appears to be the method of choice in establishing the diagnosis. Resection of th aneurysm is the recommended form of treatment.
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14
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Bogren HG, DeMaria AN, Mason DT. Imaging procedures in the detection of cardiac tumors, with emphasis on echocardiography: a review. Cardiovasc Intervent Radiol 1980; 3:107-25. [PMID: 6991115 DOI: 10.1007/bf02552329] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although cardiac tumors are relatively rare, their diagnosis is important because successful treatment is usually feasible if the diagnosis is made preoperatively. An analysis of 219 reports of cardiac tumors described in the English literature from 1972 through 1977 demonstrated the predominance of benign tumors, in particular myxoma, which is in agreement with past reviews. The methods of diagnosis employed included plain chest films, echocardiography, cardiac catheterization, angiocardiography, and cardiac scintigraphy. Conventional x-ray examination of the chest was abnormal in 83% of cardiac tumors but non-specific and should lead to further evaluation, first by echocardiography. Echocardiography, the most efficient diagnostic procedure for screening possible cardiac tumors, was abnormal in 94% of the cases. Cardiac catheterization was abnormal in 80% of cardiac tumors while definitive detection was made by angiocardiography in 94% of the cases. Cardiac scintigraphy has had limited use in the diagnosis of cardiac tumors, but has been diagnostic in 100% of the cases in a small series of myxomas.
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16
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Krueger SK, Ferlic RM, Mooring PK. Left atrial appendage aneurysm: correlation of noninvasive with clinical and surgical findings: report of a case. Circulation 1975; 52:732-8. [PMID: 1157287 DOI: 10.1161/01.cir.52.4.732] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Congenital left atrial appendage aneurysm is rarely diagnosed on the basis of an abnormal cardiac silhouette. Patients with a left atrial appendage aneurysm often present with symptoms of systemic emboli or supraventricular arrhythmias. A patient with left atrial appendage aneurysm was diagnosed by correlation of two noninvasive techniques echocardiography and radionuclide scintiscanning. Angiography was confirmatory and aneurysmectomy was successfully performed.
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17
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Congenital aneurysm of the left atrium with associated defects in the fibrous skeleton of the heart. J Thorac Cardiovasc Surg 1975. [DOI: 10.1016/s0022-5223(19)41546-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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