Enlargement of the right atrium--diverticulum or aneurysm?

Congenital right atrial diverticulum in a kitten

A four-month-old domestic shorthair cat with no clinical signs was referred for further examination of a heart murmur. An echocardiogram revealed marked right atrial dilation, extending into the left hemithorax. Computed tomography angiography was conducted to investigate further, which revealed a balloon-shaped, contrast-filled cavity on the cranial and left side of the chest that connected to the right atrium through a narrow passage. This was diagnosed as a congenital right atrial diverticulum. Treatment included clopidogrel to reduce the risk of thrombus formation. Two months after the initial diagnosis, castration surgery was successfully performed without complications. The cat died suddenly at home 10 months after diagnosis. To the authors' knowledge, this is the first right atrial diverticulum reported in a cat.

Perinatal Outcomes of Fetuses with Prenatally Diagnosed Atrial Appendage Aneurysm

To evaluate the characteristics and outcomes of fetuses with atrial appendage aneurysm (AAA) diagnosed by fetal echocardiography. The fetal echocardiography records of 1956 fetuses were evaluated retrospectively. Nine pregnancies who had been diagnosed with fetal AAA prenatally and evaluated after delivery were enrolled in the study. Perinatal and obstetric outcomes were analyzed. The incidence of fetal AAA in our series was 0.46%. Seven fetuses (77.8%) had right AAA, 1 fetus had left AAA (11.1%) and 1 fetus (11.1%) had bilateral AAA. The average gestational age at the first observation and/or diagnosis and gestational age at delivery was 22.3 ± 1.9 weeks and 34.7 ± 4.9 weeks, respectively. Incidences of associated cardiac anomaly, pericardial effusion, and nonimmune hydrops fetalis (NIHF) were 44.4%, 22.2%, and 11.1%, respectively. There was no chromosomal abnormality detected in 4 pregnancies where karyotype analysis was performed. There were 2 neonatal (22.2%) and 1 fetal (11.1%) deaths in our study group. Detailed cardiac and structural ultrasonographic examination should be performed in pregnancies with fetal AAA.

Prognostic dilemmas for SIDS in idiopathic fetal right atrium dilatation: Case report and review literature

The authors describe a case of fetal isolated right atrial enlargement or IDRA (idiopathic dilatations of the right atrium) evident in third trimester, complicated by arrhythmia in the female infant during the 1° month of life with ECG diagnosis of Wolf-Parkinson-White syndrome (WPW). The eldest sister died at 6 years because of an arrhythmia with the same diagnosis of WPW. The review of the literature on IDRA frequently shows a familial genetic aggregation. The pathogenetic mechanism underlying the dilation of the right atrium could consist of a myopathy or electrical conduction disorder. The exclusive involvement of the right atrium may be due to the increased pressure in the fetal right atrium. On the basis of our case and after review of the literature, we must be careful in defining as physiological the enlargement of the right fetal atrium in the third trimester of pregnancy. The ultrasound sign of IDRA may be a fetal prodrome of SIDS (sudden infant death syndrome).

Surgical repair of a giant congenital right atrial aneurysm concomitant with Wolff‐Parkinson‐White syndrome: A case report and literature review

Congenital right atrial aneurysms (RAA) have a wide range of clinical presentations and leads to various complications. Depending on the initial presentation and associated complications, a conservative or surgical approach may be considered. A patient suffering from a giant RAA associated with the Wolff‐Parkinson‐White syndrome, who underwent successful surgical treatment, is presented here.

Totally Endoscopic Resection of Right Atrial Diverticulum: A Case Report

Right atrial diverticulum is a rare congenital heart defect with only about 30 cases reported. Surgery is the main method of treatment and is indicated when the patients have signs of right heart compression. In this study, we report the case of a 43-year-old male patient who was diagnosed with massive right atrial diverticulum. This patient was the first case who underwent successful repair by totally endoscopic surgery on the beating heart.

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.

Echocardiographic Features of Giant Right Atrial Diverticulum in a Dog

A 12‐year‐old spayed female miniature Poodle presented for coughing, respiratory distress, and anorexia. After thoracentesis for pleural effusion, radiography revealed an enlarged cardiac silhouette with a bulge in the area of the body of the right atrium. Echocardiography revealed an anechoic chamber‐like cavity lateral to the right atrium that communicated with the right atrium through a 13 mm defect in the right atrial free wall. Contrast echocardiography and color flow Doppler were used to prove that the cavity communicated with the right atrium. The cavity was diagnosed as a giant right atrial diverticulum.

A Case of Giant Right Atrial Aneurysm in a Child

Giant right atrial aneurysm is a rare entity in infants and children. It needs to be distinguished from an atrial diverticulum, which can have similar presentation. Generally, an incidental finding in children, it can present with varied symptoms. We report a case of a giant right atrial aneurysm in an asymptomatic child with a large clot in the dilated right atrium, who underwent successful resection of the atrial aneurysm.

Giant right atrial diverticulum with thrombus formation

A 28-year-old man was referred to our hospital with a giant right atrial diverticulum. The mass of the right atrial diverticulum compressed the right atrium and right ventricle, and thrombus formation was suspected. The diverticulum was surgically excised and the patient remained asymptomatic a year later.

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.

The anatomical study of left atrium diverticulum by multi-detector row CT

The purpose of this study was to describe radiologic anatomy of the left atrium diverticulum. There were 20 patients with 27 left atrium diverticulums in 120 consecutive patients who underwent CT of coronary angiography. The presence probability of left atrium diverticulum was 16.7%, male of it was 13.0%, female was 17.6%. There was no difference on gender (P > 0.05). There were four patients accompanying with variation of pulmonary vein at one time. The diverticulum might be single or multiple, cystiform or tubiform. It could locate anterior wall or posterior wall or superior wall of left atrium. Left atrium diverticulums which was single, cystiform, and located in anterior wall were common. The cervix width of diverticulum was 4.9 +/- 3.2 mm, the body height of them was 5.4 +/- 2.0 mm. The ratio of body height to cervix width was from 0.47 to 4.08 (median 1.16). Ten patients of them undertook cardiac ultrasound examination at same time. There were five patients who left atrial diastolic function decreased, four patients who left ventricular systolic function decreased. Three of them both existed left atrial diastolic function decreasing and left ventricular systolic function decreasing, accompanied with mitral or aortic regurgitation. No patient was found that left atrium pressure or left ventricle diastolic pressure was increasing. The left atrium diverticulums of ten patients were probably congenital because their hemodynamical status cannot lead to diverticulum formation. It can be proved by reexamination after therapy or autopsy at last. In conclusion, multi-detector row computed tomography could provide anatomy details of left atrium diverticulum to help to finish heart and chest surgery successfully.

Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography

PURPOSE

To document the frequency and variations in number and anatomical shape of accessory appendages of the left atrium as seen on 64-slice cardiac CT.

METHODS AND MATERIALS

Retrospective review of the anatomy of the left atrium as depicted by cardiac CT using the acquisition protocol designed for coronary CT Angiography and performed in 166 patients over a 6-month period with a 64-slice ECG-gated CT scanner (Siemens Medical Solutions). The local IRB provided a waiver of informed consent for this retrospective study. Structures less than 5 mm in shape were excluded, as well as large accessory pulmonary veins.

RESULTS

Seventeen (17) of 166 patients (10%) had 18 accessory left atrial appendages (only one patient had two). Fifteen (15) accessory appendages were located along the right upper atrial wall and measured 0.9 x 0.6 x 0.5 cm(3) +/- 0.2 x 0.2 x 0.1 (Type 1). Three (3) were located along the left lower atrial wall, and were larger (0.9-2.5 cm cross-section) (Type 2). The right upper accessory appendages were mostly shaped like small diverticuli and the left lower ones were shaped like flat cauliflower expansions.

CONCLUSIONS

Accessory left atrial appendages were visualized in 10% of 166 patients during 64-slice coronary CT angiography.

Idiopathic enlargement of the right atrium: 23 year follow up of a familial cluster and their unaffected relatives

OBJECTIVE

To evaluate the long term outcome of familial idiopathic enlargement of the right atrium (IERA) and the risk of developing this disorder among unaffected offspring.

DESIGN

23 year follow up study.

PATIENTS

14 members (eight men, mean age 54 years, range 40-78) of a pedigree with familial IERA.

METHODS

All patients were examined clinically and echocardiographically in 1979 and 2002. Normal cross sectional dimensions of the right atrium were derived from echocardiographic evaluation of 100 people (47% men) with no structural or haemodynamic signs of heart disease. The 90th centile was chosen as the upper normal limit. IERA was defined as an increased right atrial long axis indexed to body surface area (RALAX(i), men > 2.6 cm/m2, women > 2.8 cm/m2) in the absence of other cardiac abnormalities. Severe IERA was defined arbitrarily as RALAX(i) > or = 4 cm/m2.

RESULTS

The course of the two index patients with severe IERA diagnosed in 1979 was complicated by atrial fibrillation, systemic embolism, and symptoms of heart failure without systolic dysfunction, resulting in the death of one man (77 years old). One of two patients with initially mild forms progressed to severe IERA. All of the initially unaffected offspring (n = 9) remained asymptomatic, although four of them had developed mild IERA.

CONCLUSIONS

During 23 years' follow up, severe IERA induced atrial fibrillation, systemic embolism, and symptoms of heart failure without systolic dysfunction in all cases in this family. Mild IERA seems to become manifest during middle age and may be followed by gradual progression to clinically relevant disease.