Giant right atrial aneurysm: Case report

Clinical Presentation, Diagnosis, and Management of Idiopathic Enlargement of the Right Atrium: An Analysis Based on Systematic Review of 153 Reported Cases

Idiopathic enlargement of the right atrium (IERA) is a rare cardiac anomaly, and only sporadic cases have been reported. Little is known about its clinical relevance, and inconsistencies in medical and surgical management remain among different settings. In this paper, we systematically reviewed the published cases of the IERA in terms of clinical presentation, diagnosis, and management. A total of 153 cases of IERA were covered. Arrhythmia, dyspnea, and palpitation were found to be the most common clinical manifestations. It tends to be associated with life-threatening complications and sudden cardiac death. Diagnosis was mostly established by using echocardiography. Presenting symptoms, abnormal ECG findings, and therapeutic modalities were significantly related to the prognosis of IERA. Symptomatic patients were significantly more likely to have poor outcomes than asymptomatic patients (p = 0.044), and conservative treatment was more associated with adverse outcomes compared to surgical resection (p = 0.016). In conclusion, IERA, although rare, tends to be associated with potential life-threatening complications and sudden cardiac death. Echocardiography is the most common diagnostic modality. Surgical resection is indicated for symptomatic patients.

Right atrial appendage aneurysm in a fetus-Does precise prenatal diagnosis matter?

Introduction

Congenital malformations of the right atrium-aneurysms and diverticula-are rare heart defects with only a few cases having been described prenatally. Early diagnosis of these anomalies is extremely important due to the possibility of such serious complications such as supraventricular arrhythmia, thromboembolic events and sudden death.

Topic Description

Although each of these anomalies is well known, there are still significant discrepancies in diagnosis. At the same time, there is no essential difference in the postnatal management of patients with right atrial aneurysms or diverticula. Treatment mode varies between centers and is selected individually depending on the presence of symptoms.

Discussion

We discuss the problems of terminology, ultrasound criteria and prenatal differential diagnosis, anatomic and histological features and current limitations for the accurate diagnosis of right atrial aneurysms and diverticula in utero. As a clinical example, we describe a case of right atrial appendage aneurysm diagnosed in a fetus.

Conclusions

Considering the prenatal diagnostic difficulties and similar management of such patients after birth, we suggest avoiding the use of exact terms in the fetus, leaving the precise diagnosis for the postnatal period.

Idiopathic dilatation of the right atrium: a not so benign entity

Idiopathic dilatation of the right atrium is an isolated enlargement of the right atrium in the absence of other cardiac lesions. This rare anomaly has a clinical spectrum ranging from asymptomatic to heart failure or even sudden death. It can be associated with atrial arrhythmias and thrombus formation. Antiplatelet therapy is prescribed in most cases reported in the literature, and reduction plasty is indicated when there is rapid growth of the right atrium, compression of adjacent structures, or refractory arrhythmias. We report four cases of idiopathic dilatation of the right atrium diagnosed during prenatal screening. We describe the intrauterine course and management in postnatal life until early childhood.

Congenital aneurysm of the right atrial appendage

Congenital aneurysm of the right atrial appendage is a rare cardiac anomaly with only a few reported cases in the literature. Most of the cases involved adults in their third decade of life. We report a case of congenital aneurysm of the right atrial appendage in a newborn, who initially presented with jaundice and incidentally discovered systolic murmur. The diagnosis was established by enhanced CT scan of the chest and echocardiography that also showed atrial septal defect (ASD) and multiple ventricular septal defects (VSDs). Because of its rare occurrence, diagnosis is difficult and the symptoms may be confused with other causes of right atrial dilation such as Ebstein's anomaly.

Nonseptal right atrial aneurysm: case report and review of literature

An aneurysm of the portion of the right atrium classically referred to as the subeustachian sinus is reported in a 75-year-old man with cardiac amyloidosis, AL phenotype, related to underlying multiple myeloma. A review of literature confirms the rarity of nonseptal right atrial aneurysms and their propensity to involve the subeustachian area of the right atrium which may be an intrinsic area of weakness in the atrial wall. The coincident amyloidosis in our current case suggests that hemodynamic factors may have played a role in the development of the aneurysm.

Giant right atrial aneurysm: a case report

Giant right atrial aneurysm is a very rare congenital heart defect. We report a case which was diagnosed during fetal life and operated on at 4 months of age with excision of the aneurysmal part and pericardial patch closure. Early repair is recommended to prevent late complications such as arrhythmias and thromboembolic phenomena.