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Coraducci F, Barbarossa A, Coretti F, Belleggia S, Guerra F. Giant aneurysm of the left atrial appendage: a case report. Eur Heart J Case Rep 2024; 8:ytae099. [PMID: 38434214 PMCID: PMC10908382 DOI: 10.1093/ehjcr/ytae099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024]
Abstract
Background Left atrial appendage aneurysm (LAAA) is a rare condition mostly due to congenital malformations or secondary causes (i.e. mitral regurgitation). Case summary We present a case of a 47-year-old male with a history of atrial fibrillation treated with propafenone presented to our emergency department for palpitation and epigastric pain. The electrocardiogram showed atrial fibrillation at high ventricular rate and a new-onset left bundle branch block. Urgent coronary angiogram excluded coronary artery disease. Echocardiography and cardiac magnetic resonance revealed a giant LAAA. The electrocardiogram alterations were deemed secondary to aberrancy and treatment with class IC antiarrhythmic. The patient was discussed in the heart team, and considering his will to avoid surgery, he was managed conservatively with closed follow-up, anticoagulant and antiarrhythmic therapy, and internal loop recorder. At 1-year follow-up, he showed asymptomatic and without arrhythmias. Discussion Few cases are described in the literature; therefore, there is uncertainty in treatment and prognosis. Diagnosis is achieved with multimodality imaging. Treatment can be surgical with aneurysmectomy or conservative with regular follow-up by imaging examinations and pharmacological therapy aimed to prevent complications such as thrombosis and arrhythmias. Since high-quality scientific data are lacking, shared decision-making is essential for the management of patients affected by LAAA. In our clinical case, our patient's will to not undergo surgery was considered, and therefore, a conservative management with strict follow-up and medications was chosen.
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Affiliation(s)
- Francesca Coraducci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Marche University Hospital, Via Conca 71, Ancona 60126, Italy
| | - Alessandro Barbarossa
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Marche University Hospital, Via Conca 71, Ancona 60126, Italy
| | - Francesca Coretti
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Marche University Hospital, Via Conca 71, Ancona 60126, Italy
| | - Sara Belleggia
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Marche University Hospital, Via Conca 71, Ancona 60126, Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Marche University Hospital, Via Conca 71, Ancona 60126, Italy
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2
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Norozi K, Subasri M, Diaz LA, Honjo O. Left atrial appendage aneurysm in pediatrics: Case study and literature review. Front Cardiovasc Med 2023; 10:1211619. [PMID: 37636313 PMCID: PMC10449248 DOI: 10.3389/fcvm.2023.1211619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.
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Affiliation(s)
- Kambiz Norozi
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
- Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany
| | - Mathushan Subasri
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Luis Altamirano Diaz
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
| | - Osami Honjo
- Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
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3
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Penfold MP, Haq IU, Connolly HM, Dearani JA, Schaff HV, Miranda WR, Asirvatham SJ, Killu AM, Arghami A, Stephens EH. Atrial Appendage Aneurysms: Natural History and Outcomes. World J Pediatr Congenit Heart Surg 2023; 14:474-480. [PMID: 36972504 DOI: 10.1177/21501351231162909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Left (LAAA) and right atrial appendage aneurysms (RAAA) are rare entities, and their natural history, management, and long-term outcomes are not well studied. METHODS This retrospective review includes all patients from 2000 to 2021 with atrial appendage aneurysms at our institution identified using an electronic search tool. LAAA and RAAA were confirmed using multimodality imaging and intraoperative findings. RESULTS We identified 13 (87%) patients with LAAA and 2 (13%) with RAAA. At diagnosis, 11 (73%) were female, mean age was 51.4 ± 18.8 years, and ejection fraction 56.5 ± 13.1%. Three (20%) patients had congenital heart disease including 2 (13%) with atrioventricular septal defects and 1 (7%) with congenitally corrected transposition. LAAA/RAAA was diagnosed due to new-onset atrial fibrillation (AF) in 6 (40%) patients and embolic stroke in 2 (13%). Ten patients had preexisting AF diagnosed 2.9 ± 1.4 years earlier at a mean age of 50.2 ± 15.5 years. Thrombus within the aneurysm was identified in 2 (15%) LAAA patients. All patients were on anticoagulation and follow-up of the cohort from diagnosis was 7.1 ± 6.2 years. Eleven (73%) patients were surgically managed with 7 (64%) lesions excised, 1 (9%) stapled, and 3 (27%) ligated. Postoperative complications occurred in 2 (18%) patients with 1 (7%) developing tricuspid regurgitation and another with pericardial effusion and tamponade. CONCLUSIONS Atrial appendage aneurysm is a rare disease and nearly half of patients present with AF. Surgical treatment with concomitant AF ablation is a reasonable and safe management option.
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Affiliation(s)
| | - Ikram-Ul Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Samuel J Asirvatham
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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4
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Isa H, Nakatsu T, Kimura F. Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report. J Surg Case Rep 2022; 2022:rjac549. [DOI: 10.1093/jscr/rjac549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
A left atrial appendage aneurysm (LAAA) is a rare congenital or acquired anomaly that often causes fatal complications. Although many reports recommend surgical resection for treatment, there is no clear definition of LAAA. Therefore, the diagnosis and treatment are ambiguous. A 73-year-old woman with cardiogenic stroke was admitted to our hospital because of a suspected LAAA as the source of the embolus. She was incidentally diagnosed with LAAA seven years ago, which was managed with continuous anticoagulation therapy, although atrial fibrillation was not observed. The patient underwent aneurysm resection, and the postoperative course was uneventful.As LAAA symptoms are nonspecific, careful observation is required when LAAA is suspected. The risks associated with surgery are generally low and the surgical outcome is good; however, even with appropriate medical therapy, fatal complications can occur. Therefore, surgical resection of the LAAA should be considered even in asymptomatic patients, considering the low surgical risk.
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Affiliation(s)
- Hideki Isa
- Kushiro Kojinkai Memorial Hospital Department of Cardiovascular Surgery, , Aikoku 191-212, Kushiro 085-0062, Hokkaido , Japan
| | - Tomoki Nakatsu
- Kushiro Kojinkai Memorial Hospital Department of Cardiovascular Surgery, , Aikoku 191-212, Kushiro 085-0062, Hokkaido , Japan
| | - Fumiaki Kimura
- Kushiro Kojinkai Memorial Hospital Department of Cardiovascular Surgery, , Aikoku 191-212, Kushiro 085-0062, Hokkaido , Japan
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5
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Freire M, Conversy B, De Lasalle J, Fontaine P, Rousseau‐Blass F, Pang DSJ. Surgical correction of left auricular aneurysm herniation through a pericardial defect in a dog with atrial fibrillation and mitral valve disease. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mila Freire
- Faculty of Veterinary Medicine Université de Montréal St‐Hyacinthe Québec Canada
| | - Bérénice Conversy
- Faculty of Veterinary Medicine Université de Montréal St‐Hyacinthe Québec Canada
| | | | | | | | - Daniel S. J. Pang
- Faculty of Veterinary Medicine Université de Montréal St‐Hyacinthe Québec Canada
- Faculty of Veterinary Medicine University of Calgary Calgary Alberta Canada
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Affiliation(s)
- José Cuenca Castillo
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
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7
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Surgical resection of a left auricular aneurysm in a dog. J Vet Cardiol 2019; 23:15-20. [PMID: 31174725 DOI: 10.1016/j.jvc.2018.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 12/12/2022]
Abstract
Aneurysmal dilation of the atrial appendage (auricle) is rare in humans and dogs. Congenital and acquired etiologies are hypothesized. Although right auricular aneurysm has been described in dogs, this is the first case report of an aneurysm of the left auricle of a dog with an intact pericardium. In humans, because complications of arrhythmia and thromboembolic disease have been reported, surgical resection of left auricular aneurysm is recommended. This report describes the successful surgical resection of a left auricular aneurysm in a dog, including a one-year follow up. Surgical resection can be considered in dogs with auricular aneurysm.
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8
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Resection of left atrial appendage aneurysm and full maze procedure as curative management for stroke recurrence. Gen Thorac Cardiovasc Surg 2018; 68:295-297. [PMID: 30560398 DOI: 10.1007/s11748-018-1048-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
Left atrial appendage aneurysm (LAAA) is a rare congenital heart anomaly that frequently becomes apparent after middle age. We report a case of LAAA in a 63-year-old woman with stroke. After stabilization of ischemic cerebral stroke, the patient underwent left atrial appendectomy with full maze procedure and tricuspid annuloplasty under cardiac arrest with cardiopulmonary bypasss. She has been living a healthy life without anticoagulants postoperatively. Resection and the full-maze procedure is an efficacious and durable procedure for LAAA with chronic atrial fibrillation.
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9
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Tandon R, Arisha MJ, Nanda NC, Kumar S, Wander GS, Srialluri S, Kamel H, Salama AY. Incremental benefit of three-dimensional transthoracic echocardiography in the assessment of left atrial appendage aneurysm leading to severe extrinsic compression of a coronary artery. Echocardiography 2018; 35:685-691. [DOI: 10.1111/echo.13901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Rohit Tandon
- Hero Dayanand Medical College and Hospital; Ludhiana Punjab India
| | - Mohammed J. Arisha
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham AL USA
| | - Navin C. Nanda
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham AL USA
| | - Sooraj Kumar
- Hero Dayanand Medical College and Hospital; Ludhiana Punjab India
| | | | - Swetha Srialluri
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham AL USA
| | - Hassan Kamel
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham AL USA
| | - Ahmed Y. Salama
- Division of Cardiovascular Disease; University of Alabama at Birmingham; Birmingham AL USA
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10
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Kim YW, Kim HJ, Ju MH, Lee JW. The Treatment of Left Atrial Appendage Aneurysm by a Minimally Invasive Approach. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:146-148. [PMID: 29662815 PMCID: PMC5894581 DOI: 10.5090/kjtcs.2018.51.2.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 11/16/2022]
Abstract
Left atrial appendage (LAA) aneurysm is a rare, pathologic condition that may lead to atrial tachyarrhythmia or thromboembolic events. A 49-year-old man presented with aggravated palpitation and dizziness. He suffered from refractory atrial fibrillation despite a previous history of radiofrequency catheter ablation. Echocardiography revealed a 57-mm LAA aneurysm. Surgical ablation was performed through a right mini-thoracotomy, and the LAA aneurysm was obliterated with a 50-mm AtriClip (Atricure Inc., Westchester, OH, USA). However, follow-up computed tomography showed residual communication, so the patient is still taking warfarin. We report that a minimally invasive strategy for treating LAA aneurysm can be considered, but incomplete closure may occur; thus, caution is needed.
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Affiliation(s)
- Young Woong Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Min Ho Ju
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine
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11
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Wang B, Li H, Zhang L, He L, Zhang J, Liu C, Wang J, Lv Q, Shang X, Liu J, Xie M. Congenital left atrial appendage aneurysm: A rare case report and literature review. Medicine (Baltimore) 2018; 97:e9344. [PMID: 29480827 PMCID: PMC5943883 DOI: 10.1097/md.0000000000009344] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Left atrial appendage aneurysms (LAAA) are rare. Patients with LAAA are often diagnosed incidentally or after cardiac tachyarrhythmia or systemic thromboembolism happen. Early diagnosis and surgical resection is of utmost importance to prevent hazardous adverse events. PATIENT CONCERNS We present a case of 46-year-old man with congenital LAAA. The individual in this manuscript has given written informed consent to publish these case details. DIAGNOSES Imaging studies, such as echocardiography, cardiovascular computed tomography (CT) and magnetic resonance imaging (MRI), demonstrated the large cavity arising from the left atrial appendage. The diagnosis of LAAA was confirmed. INTERVENTIONS The patient underwent an aneurysmectomy without any complications. OUTCOMES TTE confirmed the disappearance of the LAAA from the left parasternal short-axis view of the aortic root postoperatively. The patient remained asymptomatic without any adverse events at his 3-month follow-up visits. LESSONS The associated high risk of life-threatening complications and the relative ease of surgical removal suggest that prompt evaluation should be considered in patients with lesions adjacent to the left heart border.
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Affiliation(s)
- Bin Wang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - He Li
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Li Zhang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Lin He
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Jing Zhang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Cong Liu
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Jing Wang
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Qing Lv
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
| | - Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinping Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound
- Hubei Key Laboratory of Molecular Imaging
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12
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Dye L, Freed JK, Leschke JR, Pagel PS. A Rare Cause of Intermittent Dyspnea, Occasional Palpitations, and Atypical Chest Discomfort. J Cardiothorac Vasc Anesth 2017; 32:2031-2033. [PMID: 29196139 DOI: 10.1053/j.jvca.2017.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Lonnie Dye
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Julie K Freed
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Joseph R Leschke
- Department of Anesthesiology, the Medical College of Wisconsin, Milwaukee, WI
| | - Paul S Pagel
- Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI.
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13
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Huge left atrial appendage aneurysm revealed by chronic hiccups. J Saudi Heart Assoc 2017; 29:293-296. [PMID: 28983173 PMCID: PMC5623021 DOI: 10.1016/j.jsha.2017.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/19/2017] [Indexed: 02/08/2023] Open
Abstract
Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.
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14
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Valentino MA, Al Danaf J, Morris R, Tecce MA. Giant left atrial appendage aneurysm: A case of mistaken identity. J Cardiol Cases 2017; 15:129-131. [PMID: 30279759 DOI: 10.1016/j.jccase.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/23/2016] [Accepted: 12/15/2016] [Indexed: 02/08/2023] Open
Abstract
Left atrial appendage (LAA) aneurysm is a rare condition that can be congenital or acquired. Most cases are discovered incidentally. However, the most frequent clinical presentations include supraventricular tachycardias and systemic embolization. Most cases in the literature were treated by resection of the LAA, and it has been recommended to perform LAA resection even in asymptomatic patients in order to prevent thromboembolic events. Here, we describe the safe, conservative management of a patient who was initially felt to have congenital partial absence of the left pericardium but at surgery the diagnosis of LAA aneurysm was established. <Learning objective: LAA aneurysm is a rare condition which has typically been managed with prompt surgical excision due to the perceived high risk of thromboembolic events. Our case demonstrates that LAA aneurysm and its associated arrhythmias can be treated medically with AV-nodal blockade and oral anticoagulation in the asymptomatic patient. Conservative management of asymptomatic patients with a LAA aneurysm with close monitoring of LAA size may allow for a delay or possible avoidance of surgery.>.
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Affiliation(s)
- Michael A Valentino
- Thomas Jefferson University Hospital, Department of Internal Medicine, Division of Cardiology, Philadelphia, PA, USA
| | - Jad Al Danaf
- Thomas Jefferson University Hospital, Department of Internal Medicine, Philadelphia, PA, USA
| | - Rohinton Morris
- Thomas Jefferson University Hospital, Department of Surgery, Division of Cardio-thoracic Surgery, Philadelphia, PA, USA
| | - Marc A Tecce
- Thomas Jefferson University Hospital, Department of Internal Medicine, Division of Cardiology, Philadelphia, PA, USA
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15
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Bamous M, Aithoussa M, Abetti A, Boulahya A. Congenital left atrial appendage aneurysm: Atypical presentation. Ann Pediatr Cardiol 2017; 10:293-294. [PMID: 28928618 PMCID: PMC5594943 DOI: 10.4103/apc.apc_4_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Congenital left atrial appendage aneurysm is a rare condition caused by dysplasia of the atrial muscles. We report a case of a 14-year-old boy, with a 5-month history of cough and in sinus rhythm. Transthoracic echocardiography and computerized tomographic angiography confirmed the aneurysm of the left atrial appendage which was resected through median sternotomy on cardiopulmonary bypass. This case is presented not only for its rarity but also for its atypical clinical presentation.
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Affiliation(s)
- Mehdi Bamous
- Department of Cardiovascular, Cardiac Surgery Unit, Mohamed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mahdi Aithoussa
- Department of Cardiovascular, Cardiac Surgery Unit, Mohamed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Ayoub Abetti
- Department of Cardiovascular, Cardiac Surgery Unit, Mohamed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Abdelatif Boulahya
- Department of Cardiovascular, Cardiac Surgery Unit, Mohamed V Military Hospital, Mohammed V University, Rabat, Morocco
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16
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Hosseini S, Hashemi A, Saedi S, Jalili F, Maleki M, Jalalian R, Rezaei Y. Left Atrial Appendage Aneurysm. Ann Thorac Surg 2016; 102:e207-e209. [DOI: 10.1016/j.athoracsur.2016.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 01/26/2016] [Accepted: 02/04/2016] [Indexed: 11/16/2022]
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17
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Endoscopic Resection of a Giant Left Atrial Appendage. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 10:282-4. [PMID: 26355691 DOI: 10.1097/imi.0000000000000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A 23-year-old woman with a history of arterial hypertension presented to our institution complaining of dyspnea and chest pain. Her workup including echocardiography and magnetic resonance imaging revealed an aneurysm of the left atrial appendage. No thrombus was identified in the aneurysm or left atrial appendage, and the patient was in sinus rhythm. She was started on prophylactic anticoagulation, and surgical resection of the aneurysm was recommended as a definitive treatment of this lesion. The surgery was performed using a minimally invasive left-sided thoracoscopy approach. The entire left atrial appendage including the aneurysm was removed at its base using an articulating endoscopic stapler device. On postoperative echocardiography, no residual left atrial appendage tissue was evident. The patient could be taken off oral anticoagulation and left the hospital in good condition.
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18
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Ruttkay T, Scheid M, Gotte J, Doll N. Endoscopic Resection of a Giant Left Atrial Appendage. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tamas Ruttkay
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | - Michael Scheid
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | - Julia Gotte
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
| | - Nicolas Doll
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany
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19
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Gan GCH, Bhat A, Desai H, Eshoo S. Cardiac Vignette: Giant Left Atrial Appendage Aneurysm. Heart Lung Circ 2015; 24:e81-5. [PMID: 25778624 DOI: 10.1016/j.hlc.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The left atrial appendage (LAA) is a vestigial structure located in the postero-lateral aspect of the left atrium. Aneurysmal enlargement of the LAA is pathological and can predispose to adverse events, including myocardial infarction, atrial fibrillation and systemic thromboembolism. The condition is rare and usually isolated, occurring in the absence of other cardiac defects. In this cardiac vignette, we describe a case of giant left atrial appendage in a middle aged female presenting with chest pain and explore the natural history, different investigative modalities as well as issues in clinical management of this condition.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown and Mount Druitt Hospital, Sydney, NSW, Australia.
| | - Aditya Bhat
- Department of Cardiology, Blacktown and Mount Druitt Hospital, Sydney, NSW, Australia
| | - Himanshu Desai
- Department of Cardiology, Blacktown and Mount Druitt Hospital, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown and Mount Druitt Hospital, Sydney, NSW, Australia
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Aryal MR, Hakim FA, Ghimire S, Ghimire S, Giri S, Pandit A, Bhandari Y, Bhandari N, Pathak R, Karmacharya P, Pradhan R. Left atrial appendage aneurysm: a systematic review of 82 cases. Echocardiography 2014; 31:1312-8. [PMID: 24976376 DOI: 10.1111/echo.12667] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Aneurysm of the left atrial appendage is rare. We sought to systematically review the published literature on left atrial appendage aneurysm (LAAA) to address its demographic features, clinical characteristics, treatment, complications, and outcomes. METHODOLOGY A systematic electronic search of Medline, PubMed, and EMBASE for case reports, case series, and related articles of LAAA published from 1962 until July 2013 was carried out. Statistical analysis was done using SPSS version 20.0. Logistic Regression Analysis was used to identify the independent predictors of LAAA-related thrombus formation and embolism. RESULTS Eighty-two cases of LAAA were identified. There was a slight female preponderance and most of the patients presented in their third decades. Palpitation, dyspnea or both were most common clinical symptoms associated with LAAA. Echocardiography was the main diagnostic modality used and the mean size of aneurysm was 7.08 ± 3.03 × 5.75 ± 2.36 cm. Surgical resection of the aneurysm was performed in most patients with favorable results. Systemic embolism and atrial tachyarrhythmias were the two common complications associated with untreated LAAA. Presence of atrial fibrillation/flutter was the only significant predictor of thrombus formation/embolic events. CONCLUSION Aneurysm of left atrial appendage is rare and often an incidental diagnosis during echocardiography. It is important to recognize this entity since it is associated with cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia and thromboembolism. Surgical resection is the standard of treatment in the current literature. Medical management is directed toward the treatment of thromboembolism and atrial tachyarrhythmia.
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Affiliation(s)
- Madan Raj Aryal
- Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania
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Left atrial appendage aneurysm: an unusual cause of hematuria with stroke. Indian J Pediatr 2013; 80:609-10. [PMID: 22782786 DOI: 10.1007/s12098-012-0841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
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22
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Atrial fibrillation with a giant left atrial appendage can be successfully treated with pulmonary vein antrum isolation. Neth Heart J 2012; 20:179-81. [PMID: 21604103 PMCID: PMC3303027 DOI: 10.1007/s12471-011-0166-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Tangential Triangular Resection An Option to Treat the Giant Left Atrium. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010; 5:125-7. [DOI: 10.1097/imi.0b013e3181d8c55c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 21-year-old woman presented with congestive heart failure caused by congenital mitral and tricuspid insufficiency, associated with great left atrium enlargement. Transthoracic echo-cardiogram revealed heart dextroversion associated with mitral and tricuspid severe insufficiency and left atrium enlargement (14 cm), confirmed by magnetic resonance study. The left atrium was reduced by a tangential triangular resection of the posterior wall, between the pulmonary veins, suturing the edges of the left atrium with bovine pericardium strip reinforcement. Mitral and tricuspid valves were repaired. The postoperative course was uneventful, and the patient was discharged in the 15th postoperative day. A control magnetic resonance study revealed a 50% reduction in left atrium size. Evolution of left atrium resection is excellent, with low recurrence of arrhythmias, embolism, or heart failure.
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Pomerantzeff PMA, Brandão CMA, Guedes MAV, Stolf NAG. Tangential Triangular Resection An Option to Treat the Giant Left Atrium. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2010. [DOI: 10.1177/155698451000500211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Pablo M. A. Pomerantzeff
- Department of Cardiothoracic Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos M. A. Brandão
- Department of Cardiothoracic Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Marco A. V. Guedes
- Department of Cardiothoracic Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Noedir A. G. Stolf
- Department of Cardiothoracic Surgery, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
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DeSena HC, Niyazov DM, Parrino PE, Lucas VW, Shah SB, Moodie DS. An Unusual Cardiac Defect in a Patient with Clinical Features Overlapping Between Cardiofaciocutaneous and Noonan Syndromes. CONGENIT HEART DIS 2010; 5:70-5. [DOI: 10.1111/j.1747-0803.2009.00329.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Erstdiagnose eines Aneurysmas des linken Vorhofohres bei einer 69-jährigen Patientin. ACTA ACUST UNITED AC 2009; 104:875-7. [DOI: 10.1007/s00063-009-1184-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
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27
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Wilson D, Kalra N, Brody EA, Van Dyk H, Sorrell VL. Left Atrial Appendage Aneurysm-A Rare Anomaly with an Atypical Presentation. CONGENIT HEART DIS 2009; 4:489-93. [DOI: 10.1111/j.1747-0803.2009.00319.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ren J, Patel RV, McIsaac KA, Guiraudon G, Peters TM. Dynamic 3-D virtual fixtures for minimally invasive beating heart procedures. IEEE TRANSACTIONS ON MEDICAL IMAGING 2008; 27:1061-1070. [PMID: 18672424 DOI: 10.1109/tmi.2008.917246] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Two-dimensional or 3-D visual guidance is often used for minimally invasive cardiac surgery and diagnosis. This visual guidance suffers from several drawbacks such as limited field of view, loss of signal from time to time, and in some cases, difficulty of interpretation. These limitations become more evident in beating-heart procedures when the surgeon has to perform a surgical procedure in the presence of heart motion. In this paper, we propose dynamic 3-D virtual fixtures (DVFs) to augment the visual guidance system with haptic feedback, to provide the surgeon with more helpful guidance by constraining the surgeon's hand motions thereby protecting sensitive structures. DVFs can be generated from preoperative dynamic magnetic resonance (MR) or computed tomograph (CT) images and then mapped to the patient during surgery. We have validated the feasibility of the proposed method on several simulated surgical tasks using a volunteer's cardiac image dataset. Validation results show that the integration of visual and haptic guidance can permit a user to perform surgical tasks more easily and with reduced error rate. We believe this is the first work presented in the field of virtual fixtures that explicitly considers heart motion.
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Affiliation(s)
- Jing Ren
- University of Ontario Institute of Technology, Oshawa, ON, L1H 7K4 Canada
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29
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Affiliation(s)
- Refeng Yao
- Department of Anesthesiology and Pain Medicine, Caritas St Elizabeth's Medical Center, Boston, MA 02135, USA
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de la Fuente A, Urchaga A, Sánchez R, Fernández JL, Moriones I. Congenital aneurysm of the left atrial appendage. Ann Thorac Surg 2008; 85:2139-40. [PMID: 18498847 DOI: 10.1016/j.athoracsur.2007.12.064] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 12/20/2007] [Accepted: 12/26/2007] [Indexed: 01/01/2023]
Abstract
Aneurysm of the left atrial appendage (LAA) is very infrequent. We present the case of 24-year-old man in functional class I with atrial fibrillation but no other symptoms. Radiology showed an abnormality in the outline of the heart. Echocardiography revealed left appendage aneurysm. After median sternotomy, aneurysmectomy was performed under cardiopulmonary bypass without cross clamping. Atrial fibrillation ceased as soon as the aneurysm had been removed. There were no postoperative complications. Three months later the patient remained asymptomatic and in sinus rhythm.
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31
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Vagefi PA, Choudhry M, Hilgenberg AD. Excision of an aneurysm of the left atrial appendage. J Thorac Cardiovasc Surg 2007; 133:822-3. [PMID: 17320601 DOI: 10.1016/j.jtcvs.2006.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Accepted: 11/16/2006] [Indexed: 12/01/2022]
Affiliation(s)
- Parsia A Vagefi
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass 02114-2696, USA.
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Conradi G, Deetjen A, Möllmann S, Hamm CW, Dill T. Symptomatic atrial fibrillation as the first symptom of a giant left atrial appendage aneurysm. Clin Res Cardiol 2006; 95:614-6. [PMID: 16897139 DOI: 10.1007/s00392-006-0432-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 06/23/2006] [Indexed: 10/24/2022]
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