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Vaideeswar P, Zare P, Bhatia P. Unusual cardiac aneurysms: a surgical pathology experience. Cardiovasc Pathol 2024; 72:107662. [PMID: 38815840 DOI: 10.1016/j.carpath.2024.107662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
Among the cardiac outpouchings, left ventricular aneurysms or pseudo-aneurysms that develop secondary to myocardial infarctions are the most common. On the other hand, atrial appendageal and valvular aneurysms are uncommon occurrences. The appendageal aneurysms develop possibly due to congenital dysplasia of atrial pectinate muscles, while valvular aneurysms result from infective endocarditis, mechanical injury or degenerative changes. Despite their unusual locations, they are prone to life-threatening complications. We present our experience of unusual cardiac aneurysms in surgical cardiovascular material.
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Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India.
| | - Pranita Zare
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Pranav Bhatia
- Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
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Qin K, Teng P, Shi L, Ma L. A rare case of left atrial appendage aneurysm. J Cardiothorac Surg 2024; 19:327. [PMID: 38849837 PMCID: PMC11157939 DOI: 10.1186/s13019-024-02629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/09/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Left atrial appendage aneurysm is a rare cardiac mass, with only a few cases reported. There are usually no specific symptoms, and a few patients visit the doctor with symptoms. CASE PRESENTATION A 20-year-old male presented to our hospital with a "pericardial cyst found by medical evaluation in another hospital for 2 years." Cardiac ultrasound performed at clinics of our hospital suggested a cystic dark area in the left ventricular lateral wall and the anterior lateral wall, consistent with a pericardial cyst and mild mitral regurgitation. After further relevant examinations and ruling out contraindications, an excision of the left atrial appendage aneurysm was performed under general anesthesia and cardiopulmonary bypass with beating-heart. The postoperative pathological results identified that: (left atrial appendage) fibrocystic wall-like tissue with a focal lining of the flat epithelium, consistent with a benign cyst. CONCLUSION Left atrial appendage aneurysms are rare and insidious. They are usually found by chance during medical evaluations. If the location is not good or the volume is too large, then compression symptoms or arrhythmia, thrombosis and other concomitant symptoms will occur. Surgical resection is presently the only effective radical cure for a left atrial appendage aneurysm.
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Affiliation(s)
- Ke Qin
- Department of Cardiovascular Surgery, The First Affifiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China
| | - Peng Teng
- Department of Cardiovascular Surgery, The First Affifiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China
| | - Liping Shi
- Department of Cardiovascular Surgery, The First Affifiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China.
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affifiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, 310003, China.
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Abuzahra S, Odeh A, Khdour I, Nairat M, Azamtta M, Saifi M, Younis O, Daralammouri Y. Imaging reveals a fifth heart chamber: Diagnosing and treating a massive left atrial appendage aneurysm. Radiol Case Rep 2024; 19:1136-1140. [PMID: 38259714 PMCID: PMC10801141 DOI: 10.1016/j.radcr.2023.11.049] [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: 10/27/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024] Open
Abstract
In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.
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Affiliation(s)
- Saad Abuzahra
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Anas Odeh
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Issa Khdour
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiothoracic Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Muath Nairat
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiothoracic Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Murad Azamtta
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Motaz Saifi
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Omar Younis
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Yunis Daralammouri
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiology, An-Najah National University Hospital, Nablus, 44839, Palestine
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4
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Ayala Torres JD, Sepulveda Gallego JA, Gonzalez Gonzalez M. Left Atrial Appendage Aneurysm: A Case Report and Literature Review. Cureus 2024; 16:e56280. [PMID: 38623095 PMCID: PMC11018009 DOI: 10.7759/cureus.56280] [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] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
The left atrial appendage aneurysm is an uncommon condition that has garnered attention from the medical community due to its low incidence and varied clinical manifestations. The difficulty in identification is reflected in its incidental detection in imaging studies such as echocardiograms and tomographies, while symptoms range from mild to severe, including heart failure and thromboembolic events. The complex etiology includes congenital and acquired factors, and its management focuses on preventing complications through surgical resection, accompanied by medical strategies such as controlling heart rhythm and anticoagulation. The case of a 67-year-old woman with significant medical history illustrates these challenges. Despite an inconclusive initial diagnosis, a tomography revealed an aneurysm with an intracavitary thrombus, leading to successful surgical resection. However, subsequent infectious complications resulted in her death. The average age of diagnosis is around 30 years, and while it is more common in women, there are no significant gender differences. Surgical management remains the preferred option, especially in severe cases, although in some patients, a watchful waiting approach is chosen. In conclusion, the left atrial appendage aneurysm is a complex entity that requires a multidisciplinary approach to improve clinical outcomes. Early diagnosis and appropriate treatment are crucial to prevent serious complications and improve the quality of life of affected patients.
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Xiong J, Wenbo Y, Gao J, Li M, Yu D. Radiofrequency ablation-induced superior vena cava stenosis in a 5-year-old boy with congenital left atrial appendage deformity: a case report and literature review. Front Surg 2023; 10:1199335. [PMID: 37492621 PMCID: PMC10365907 DOI: 10.3389/fsurg.2023.1199335] [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: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Superior vena cava (SVC) stenosis is rarely caused by iatrogenic trauma. Herein, the case of a 5-year-old boy who underwent radiofrequency ablation for paroxysmal supraventricular tachycardia but developed SVC stenosis and related syndromes is reported. Notably, the child exhibited an enlarged left atrial appendage that had partially breached the pericardium. Subsequent interventions involved successful removal of the stenosis, artificial vascular reconstruction, and comprehensive radiofrequency ablation of the entire right atrium, along with ligation of the left atrial appendage under direct vision. As a result, the child experienced relief from symptoms.
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Affiliation(s)
- Jianxian Xiong
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yu Wenbo
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Jianfeng Gao
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Meifang Li
- Department of Breast Disease Comprehensive Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Dongmin Yu
- Department of Breast Disease Comprehensive Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Li R, Ma F, Guan HX, Pan YY, Liu LG, Wang DW, Wang H. Case Report: Giant Congenital Left Atrial Appendage Aneurysm Presenting With Acute Massive Cerebral Infarction and Refractory Atrial Fibrillation: A Case Report and Literature Review. Front Cardiovasc Med 2022; 9:888825. [PMID: 35620516 PMCID: PMC9127081 DOI: 10.3389/fcvm.2022.888825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022] Open
Abstract
Background Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with a variety of presentations, from being asymptomatic to potentially serious complications such as systemic thromboembolism and atrial tachyarrhythmia. Case Presentation We report a case of congenital giant LAAA in a 35-year-old man presenting with acute massive cerebral infarction and atrial fibrillation (AF) with rapid ventricular rate. The AF was refractory to conventional antiarrhythmic agents, such as amiodarone and electrical cardioversion, but restored and maintained sinus rhythm after surgical resection of LAAA. The patient remained free of events and was in sinus rhythm during half-year follow-up. Conclusion Giant LAAA has the potential causing serious complications and should be managed surgically in most cases.
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Affiliation(s)
- Rui Li
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han Xiong Guan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Ying Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Gang Liu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hong Wang,
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7
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Renapurkar R, Ghosh S. Congenital Left Atrial Aneurysms. Radiology 2022; 304:38-39. [PMID: 35380496 DOI: 10.1148/radiol.212565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Online supplemental material is available for this article.
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Affiliation(s)
- Rahul Renapurkar
- From the Department of Thoracic Imaging, Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, Ohio 44195 (R.R., S.G.); and Department of Radiology, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (S.G.)
| | - Subha Ghosh
- From the Department of Thoracic Imaging, Imaging Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, Ohio 44195 (R.R., S.G.); and Department of Radiology, Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio (S.G.)
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8
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Wang X, Liu JJ, Han JC, Sun L, Zhang Y, Gu XY, Xue C, Liu XW, He YH. Fetal atrial appendage aneurysm: Prenatal diagnosis by echocardiography and prognosis. Echocardiography 2021; 38:1228-1234. [PMID: 34075626 DOI: 10.1111/echo.15089] [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: 01/31/2021] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Congenital atrial appendage aneurysm (AAA) is a rare malformation which can coexist with potentially lethal complications. We aimed to summary echocardiographic characteristics and prognosis of fetal AAA. METHODS We retrospectively analyzed the echocardiographic data of 17 fetuses with AAA,and their outcomes or pathological reports were also collected. RESULTS Eight fetuses with left AAA (LAAA) and 9 fetuses with right AAA (RAAA) were identified. Five fetuses were diagnosed with other cardiac defects. Two fetuses with RAAA presented with arrhythmias, including atrial premature beats (n = 1) and bradyarrhythmia (n = 1). LAAA could be detected by four-chamber view (50.0%) and short-axis view (100.0%). RAAA could be detected by four-chamber view (100.0%), and view of right ventricular inflow tract (33.3%). There were three cases with mild pericardial effusion. Three cases with complex cardiac defects were selectively terminated, with confirmation of LAAA by autopsy in one case. Fourteen fetuses were born. After following 2 (range, 1-5) years, the AAA disappeared in one case with LAAA and two cases with RAAA. While, 11 cases were still diagnosed with AAA. Atrial premature beats with RAAA, which appeared in prenatal period, still persisted after birth. CONCLUSION Congenital AAA is a rare abnormality in utero. The short-axis view and the four-chamber view were the most useful views to detect fetal AAA. Fetal AAA may disappear in childhood. Atrial tachyarrhythmias in utero may exist persistently after birth. Patients with AAA should be followed up closely and appropriate intervention should be taken when complications appeared.
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Affiliation(s)
- Xin Wang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing-Jing Liu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jian-Cheng Han
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Gu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chao Xue
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao-Wei Liu
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi-Hua He
- Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.,Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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9
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Masson AV, Maddox TW, Bode EF, Mortier JR. Clinical and diagnostic imaging findings in dogs with atrial appendage aneurysm: 7 cases (2014-2020). J Vet Cardiol 2021; 35:63-73. [PMID: 33866275 DOI: 10.1016/j.jvc.2021.03.002] [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: 05/27/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION/OBJECTIVE Atrial appendage aneurysm in dogs is a rare condition and has not been well described. The aim of this study is to describe clinical and diagnostic imaging findings, especially computed tomography (CT), of atrial appendage aneurysms in dogs. ANIMALS Seven client-owned dogs with a presumptive diagnosis of left or right atrial appendage aneurysm. MATERIALS AND METHODS Retrospective study. Medical records were searched to identify dogs with a presumptive diagnosis of left (LAAA) or right atrial appendage aneurysm (RAAA). Signalment, history, examination findings, diagnostic test results, and imaging procedures were reviewed. Archived diagnostic images were retrieved and evaluated by two board-certified radiologists and a board-certified cardiologist. Data analysis was descriptive. RESULTS Six cases were diagnosed with RAAA and one with LAAA with a median age of 8 years. Five affected dogs were small to medium-breed male dogs. All dogs underwent a thoracic CT examination for various reasons and all cases of RAAA were incidental findings. CT was useful to identify and assess the atrial appendage aneurysm, as well as neighboring structures, although possible pericardial defects could not be visualized. Five dogs had a concurrent echocardiographic examination, which successfully identified the LAAA and two RAAA. CONCLUSIONS This case series described the clinical and CT findings in seven dogs with atrial appendage aneurysm, as well as echocardiographic findings in five of these cases. Right atrial appendage aneurysms appear to be mainly incidental findings. CT seems to be more sensitive than echocardiography in the detection of atrial appendage aneurysm.
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Affiliation(s)
- A V Masson
- Ecole Nationale Vétérinaire de Maisons-Alfort, 7 avenue du Général de Gaulle, 94700 Maisons-Alfort, France.
| | - T W Maddox
- Small Animal Teaching Hospital, University of Liverpool - Institute of Veterinary Science, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - E F Bode
- Small Animal Teaching Hospital, University of Liverpool - Institute of Veterinary Science, Chester High Road, Neston, CH64 7TE, United Kingdom
| | - J R Mortier
- Small Animal Teaching Hospital, University of Liverpool - Institute of Veterinary Science, Chester High Road, Neston, CH64 7TE, United Kingdom; Chestergates Veterinary Specialists, Telford Court, Units E and F, Gates Lane, Chestergates CH1 6LT, United Kingdom
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Kothandam S, Ramasamy R. Planning and execution of catheter closure of a giant left atrial appendage aneurysm causing recurrent cardioembolism. Ann Pediatr Cardiol 2020; 13:353-356. [PMID: 33311928 PMCID: PMC7727907 DOI: 10.4103/apc.apc_76_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/27/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023] Open
Abstract
Giant left atrial appendage aneurysms (LAAAs) are rare causes of recurrent cardioembolism and managed routinely by surgery. A first catheter closure of a giant LAAA is reported, when a recent cerebral infarct precluded immediate surgery. Planning included ostial measurement on multimodal imaging, echo navigation for septal puncture, rotational angiogram for profiling, overlay imaging for device placement, and cerebral embolic protection from thrombus debris.
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Affiliation(s)
- Sivakumar Kothandam
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Rajeshkumar Ramasamy
- Department of Pediatric Cardiology, Madras Medical Mission, Chennai, Tamil Nadu, India
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An 8-Year-Old Boy With a Giant Left Atrium. Chest 2020; 158:e59-e64. [PMID: 32768077 DOI: 10.1016/j.chest.2020.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/04/2020] [Accepted: 02/27/2020] [Indexed: 11/20/2022] Open
Abstract
CASE PRESENTATION An 8-year-old boy was referred to our institution because of nausea and vomiting for 1 day. He had also been experiencing shortness of breath for more than 1 year. This symptom had progressed so that he could no longer run or walk upstairs without chest discomfort. There was no associated fever, diarrhea, or coughing. He had a history of heart murmur that was diagnosed in another clinic 4 years ago. Echocardiogram 4 years prior suggested mild to moderate biatrial enlargement with trivial mitral valve regurgitation. He did not go in for any follow-up until this admission. He had no other associated diseases, nor use of medicine.
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12
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Shams KA. When the left atrium becomes a monster: a case report. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 32974461 PMCID: PMC7501917 DOI: 10.1093/ehjcr/ytaa128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/30/2019] [Accepted: 04/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Congenital left atrium (LA) aneurysms are extremely rare entities in clinical practice and most frequently involve the atrial appendage and rarely arise from the body of LA, We report a case of giant LA aneurysm compressing heart and presenting in a very late stage. CASE SUMMARY A 31-year-old male, who was diagnosed to have dextrocardia, rheumatic heart disease, and atrial fibrillation and was kept on medical treatment long time ago, presented with congestive heart failure symptoms and cardiogenic shock. Emergency transthoracic echocardiography was done revealing situs solitus with aneurysmally dilated LA pushing heart to the right side (dextro-posed heart), moderate mitral regurgitation, and severe pulmonary hypertension, however, pulmonary artery anatomy could not be properly visualized so computed tomography (CT) was preformed confirming diagnosis and revealing compressed pulmonary arterial tree by the dilated LA, unfortunately patient died before proceeding to surgical intervention. DISCUSSION Congenital left atrial aneurysms are extremely rare anomaly and may be associated with significant morbidity. And, therefore, should be remembered as a potential anatomic cause of atrial arrhythmias or embolic phenomena, or both. The diagnosis may be easily established through non-invasive complementary techniques, such as echocardiography, CT, and cardiac magnetic resonance imaging. Symptomatic patients, those with large aneurysm or compelling indications for surgery should undergo surgical resection.
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Affiliation(s)
- Khaled A Shams
- Cardiology Department, Faculty of Medicine - Helwan University, Ain Helwan, Cairo 11471, Egypt
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13
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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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14
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Nezafati MH, Nazari Hayanou H, Kahrom M, Khooei A, Nezafati P. Five chambered heart: case of a huge left atrial appendage aneurysm. Cardiovasc Pathol 2018; 34:43-45. [PMID: 29574291 DOI: 10.1016/j.carpath.2018.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 11/30/2022] Open
Abstract
Aneurysmal enlargement of the left atrial appendage is an extremely rare pathology and can predispose to adverse events, including cardiac arrest, respiratory distress, arrhythmia, heart failure, systemic thromboembolism, or rupture. It is usually diagnosed incidentally or after the occurrence of atrial tachyarrhythmias or thrombotic events in the second to fourth decades of life. We describe a rare case of a symptomatic giant congenital left atrial appendage aneurysm (LAAA) in a 26-year-old man presenting with neurologic event, in whom surgical resection of the aneurysm was successfully performed. This is the largest LAAA reported in the literature so far.
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Affiliation(s)
| | | | - Mahdi Kahrom
- Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Khooei
- Department of Pathology, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Pouya Nezafati
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medicine Sciences, Isfahan, Iran.
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15
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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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16
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Chen Y, Mou Y, Jiang LJ, Hu SJ. Congenital giant left atrial appendage aneurysm: a case report. J Cardiothorac Surg 2017; 12:15. [PMID: 28302138 PMCID: PMC5356375 DOI: 10.1186/s13019-017-0576-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/21/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with potentially serious complications, including life-threatening systemic thromboembolism, atrial tachyarrhythmia, and cardiac dysfunction. Currently, early surgical intervention is generally recommended to prevent these complications. CASE PRESENTATION We present a case of congenital giant LAAA in a female patient who successfully completed pregnancy and underwent caesarean section with no obvious complications. Surgical resection of the LAAA was performed 3 years later, at the onset of chest pain resulting from compression of adjacent cardiac structures by the LAAA. CONCLUSION Surgical resection is recommended for the majority of patients with LAAA because of potential LAAA-related severe outcomes. However, clinical monitoring may be an optional strategy for asymptomatic patients without intra-atrial thrombus or other complications. Precise evaluation with echocardiography and brain magnetic resonance imaging is valuable for the subsequent management of LAAA.
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Affiliation(s)
- Yan Chen
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yun Mou
- Echocardiography and Vascular Ultrasound Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Li-Jun Jiang
- Department of Thoracic Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shen-Jiang Hu
- Institute of Cardiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No.79, Qing-Chun Road, Hangzhou, China.
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17
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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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18
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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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19
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Abstract
A 14-year-old boy with sudden onset of palpitations and dyspnea was found to have an intrapericardial left atrial aneurysm (15 × 12 cm). Left atrial aneurysmectomy was carried out under cardiopulmonary bypass. The patient has been symptom-free during a 1-year follow-up.
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Affiliation(s)
| | | | - Kuldip S Sidhu
- Department of Cardiovascular and Thoracic Surgery Government Medical College Amritsar, Punjab, India
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20
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Bharati A, Merhcant S, Nagesh C, Bansal A. The "giant dog ear" sign of left atrial appendage aneurysm—revisited on 3 T cardiac MRI (free-breathing, non-contrast). BJR Case Rep 2016; 2:20150292. [PMID: 30364422 PMCID: PMC6195934 DOI: 10.1259/bjrcr.20150292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 09/17/2015] [Accepted: 09/17/2015] [Indexed: 11/05/2022] Open
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21
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Combination of congenital left atrial appendage aneurysm in an infant with transposition of the great arteries: a previously unreported association. Cardiol Young 2015. [PMID: 26205429 DOI: 10.1017/s1047951115001420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 35-day-old boy weighing 4.5 kg was referred to our department from a general paediatric hospital due to low oxygen saturation. His transcutaneous oxygen saturation was 75%. Transthoracic echocardiography showed discordant ventriculo-arterial connections, a non-restrictive atrial septal defect, and patent ductus arteriosus, in addition to a 23 mm×10-mm left atrial appendage aneurysm. As far as we know, this association has not been reported previously in the literature.
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22
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Abstract
A 20 year-old woman presented with systemic embolisation. On subsequent investigation, she was diagnosed with a congenital left atrial appendage aneurysm. Few case reports are reported in the literature. This cardiac malformation presents a diagnostic challenge in patients with cardiomegaly.
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23
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Mandegar MH, Moradi B, Roshanali F, Ojaghi Z. Giant left atrial aneurysm. J Cardiol Cases 2014; 10:144-146. [PMID: 30534227 DOI: 10.1016/j.jccase.2014.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/04/2014] [Accepted: 06/20/2014] [Indexed: 10/25/2022] Open
Abstract
Congenital aneurysmal dilatation of the left atrium is a rare anomaly that could be associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe a 32-year-old man with a giant left atrial aneurysm diagnosed with new imaging modalities that underwent surgical resection with good results. <Learning objective: Left atrial aneurysms are rare and characterized by their origin from an otherwise normal atrium, a clearly defined communication with the atrial cavity, and their intrapericardial location. Because of associated complications, early diagnosis and surgical excision are mandatory even in asymptomatic, otherwise healthy patients. The evaluations with cardiac imaging techniques should be considered in any patient with an unexplained abnormality on the chest radiograph or initial echocardiography.>.
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Affiliation(s)
| | - Bahieh Moradi
- Department of Echocardiography, Day General Hospital, Tehran, Iran
| | | | - Zahra Ojaghi
- Department of Echocardiography, Shaheed Rajaei Heart Center, Tehran, Iran
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24
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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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25
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Kuiten WMM, de Heer LM, van Aarnhem EEHL, Onsea K, van Herwerden LA. Giant left atrial appendage: a rare anomaly. Ann Thorac Surg 2013; 96:1478-1480. [PMID: 24088468 DOI: 10.1016/j.athoracsur.2013.01.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/05/2013] [Accepted: 01/10/2013] [Indexed: 11/25/2022]
Abstract
A giant left atrial appendage is a rare congenital anomaly that has been reported on only a few occasions. We report two symptomatic patients with atrial fibrillation combined with a cerebellar infarct in one and dyspnea in the other. Both patients were treated surgically with resection of the giant left atrial appendage and radiofrequency pulmonary vein isolation. Recognition of this uncommon pathology can lead to timely surgical intervention.
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Affiliation(s)
- Wilhelmina M M Kuiten
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Linda M de Heer
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, The Netherlands
| | | | - Kevin Onsea
- Department of Cardiology, University Medical Centre Utrecht, The Netherlands
| | - Lex A van Herwerden
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, The Netherlands.
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26
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Sarin SS, Bindra T, Chhabra GS. A giant left atrial appendage aneurysm with a large pinball-like thrombus in a 2 year old. Ann Pediatr Cardiol 2012; 5:215-6. [PMID: 23129921 PMCID: PMC3487220 DOI: 10.4103/0974-2069.99634] [Citation(s) in RCA: 4] [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: 01/20/2023] Open
Abstract
Congenital left atrial appendage aneurysm is very rare. We describe a giant left atrial appendage aneurysm with a pinball-like mobile thrombus in a 2-year-old child with cardioembolic stroke. Patient underwent successful surgical resection of the aneurysm.
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Affiliation(s)
- Simarjot Singh Sarin
- Department of Cardiology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India
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27
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Congenital left atrial appendage aneurysm: a case report and brief review of literature. Heart Lung Circ 2008; 18:412-6. [PMID: 19119072 DOI: 10.1016/j.hlc.2008.10.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2007] [Revised: 05/05/2008] [Accepted: 10/03/2008] [Indexed: 02/08/2023]
Abstract
A 28-year-old woman with congenital aneurysm of the left atrial appendage was successfully treated by aneurysmectomy and is reported for its rarity. The exact diagnosis is relatively easy to make by contrast echocardiography, magnetic resonance imaging, and/or computerised tomographic angiography, provided the possibility is entertained. Because of supraventricular arrhythmias and systemic thromboembolism, surgical resection was deemed the best curative option to avoid further episodes and recurrence. Published reports detailing the diagnostic evaluation and surgical management for congenital left atrial appendage aneurysm are also discussed.
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28
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Nomura K, Matsumura Y, Shinohara G, Nakamura Y. A 4-year-old girl with giant left atrial diverticulum resulting in severe mitral regurgitation. Cardiovasc Pathol 2008; 17:254-5. [PMID: 18402786 DOI: 10.1016/j.carpath.2007.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 03/31/2007] [Accepted: 04/10/2007] [Indexed: 10/23/2022] Open
Abstract
Left atrial diverticulum is rare in a pediatric patient. A 4-year-old girl underwent a left atrial plication concomitant with mitral valve replacement, and early postoperative course was uneventful. This patient has remained asymptomatic with no evidence of recurrent diverticular formation after 9 months of follow-up.
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Affiliation(s)
- Koji Nomura
- Department of Cardiovascular Surgery, Saitama Children's Medical Center, 2100 Magome, Iwatsuki, Saitama 339-8551, Japan.
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29
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Dumitrescu A, Walsh KP, Wood AE. Giant left atrial appendage with a common ventricular-appendicular wall and an abnormal course of the circumflex coronary artery in an asymptomatic 18-month-old girl. Pediatr Cardiol 2008; 29:431-3. [PMID: 17896126 DOI: 10.1007/s00246-007-9108-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 07/06/2007] [Accepted: 07/08/2007] [Indexed: 10/22/2022]
Abstract
We present a congenital giant left atrial appendage in an asymptomatic 18-month-old girl featuring two morphological aspects not yet described, namely, a common wall between the giant left atrial appendage and the left ventricle and an abnormal course of the circumflex coronary artery across the surface of the grossly dilated left atrial appendage which prohibited its radical resection. Surgery was performed off-bypass, via anterolateral thoracotomy with plication of the aneurysm, leaving a residual pouch. A patch closure of the communicating os between the left atrium and the residual aneurysm was therefore undertaken later. Radical surgical resection is recommended for giant left atrial appendage if complications are to be avoided, as there is potential for progressive growth, intracardiac thrombosis, systemic embolization, cardiac arrhythmia, and need for life-long anticoagulation.
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Affiliation(s)
- Anita Dumitrescu
- Department of Paediatric Cardiology, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland
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30
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Pomerantzeff PMA, Freyre HM, de Almeida Brandão CM, Pereira Barreto AC, Almeida de Oliveira S. Aneurysm of the left atrial appendage. Ann Thorac Surg 2002; 73:1981-3. [PMID: 12078814 DOI: 10.1016/s0003-4975(02)03408-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We present the case of a 33-year-old woman with atrial tachyarrhythmias and chest pain. The transthoracic echocardiography demonstrated an intrapericardial liquid mass confirmed as an aneurysm of the left atrial appendage by a nuclear magnetic imaging study. Aneurysmectomy was performed with the assistance of cardiopulmonary bypass with a bilateral submammary skin incision and subsequent median sternotomy. The patient had an uneventful postoperative course. We suggest aneurysmectomy aided by cardiopulmonary bypass as a safer method of treatment for this rare cardiac anomaly.
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31
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Wang D, Holden B, Savage C, Zhang K, Zwischenberger JB. Giant left atrial intrapericardial aneurysm: noninvasive preoperative imaging. Ann Thorac Surg 2001; 71:1014-6. [PMID: 11269416 DOI: 10.1016/s0003-4975(00)02447-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Congenital giant intrapericardial aneurysms of the left atrium are rare. A 17-year-old boy presented with paroxysmal episodes of palpitations, chest pain, and dyspnea. A chest roentgenogram showed an enlarged left cardiac silhouette. Transthoracic echocardiography imaging showed an intrapericardial aneurysm of the left atrium. Cardiac magnetic resonance imaging confirmed the diagnosis and delineated adjacent structures to plan the surgical resection. We have found no previous reports of cases of diagnosis and preoperative assessment based solely on noninvasive imaging.
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Affiliation(s)
- D Wang
- Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases of Tongji Medical University, Wuhan, China
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32
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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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33
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Kunishima T, Musha H, Yamamoto T, Aoyagi H, Kongoji K, Imai M, Ozawa A, So T, Nagashima J, Murayama M. Congenital giant aneurysm of the left atrial appendage mimicking pericardial absence case report. JAPANESE CIRCULATION JOURNAL 2001; 65:56-9. [PMID: 11153824 DOI: 10.1253/jcj.65.56] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 25-year-old man was found to have an abnormal cardiac contour on a chest radiograph, and was referred. Transesophageal echocardiography suggested herniation of the left atrial appendage (LAA) through a gap in the pericardium, and magnetic resonance imaging indicated congenital partial absence of the pericardium. Cardiac dysfunction was caused by compression from the enlarged left atrium and thrombi were thought to be present in the appendage, so surgery was performed. The intraoperative diagnosis was congenital LAA aneurysm. Although distinguishing between congenital LAA aneurysm and congenital absence of the pericardium is reported to be possible with magnetic resonance imaging, we were unable to so in this case.
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Affiliation(s)
- T Kunishima
- Department of Cardiology, Yokohama Seibu Hospital, St Marianna University, Japan
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34
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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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35
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Karatasakis GT, Beldekos DI, Makos GS, Sfirakis PD, Cokkinos DV. Resolution of Thrombi in Left Atrial Appendage Aneurysm. Echocardiography 1997; 14:161-162. [PMID: 11174938 DOI: 10.1111/j.1540-8175.1997.tb00705.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Atrial appendage aneurysm is a rare cardiac disease and may be complicated by embolic events and rhythm disturbances. We describe a case of a congenital left atrial aneurysm presenting with a cerebrovascular accident in a 57-year-old female. The diagnosis was made by transesophageal echocardiography, which revealed the presence of intraaneurysmal thrombi. The patient initially received anticoagulant therapy and the thrombi were resolved. Subsequently, she was successfully operated on and the aneurysm was removed. This is the first report of thrombi resolution in a left atrial appendage aneurysm.
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36
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Kwan CM, Tsai LM, Lin LJ, Yang YJ, Chen JH. Congenital left atrial appendage aneurysm with thrombus formation: diagnosis by transesophageal echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 1993; 21:480-483. [PMID: 8370812 DOI: 10.1002/jcu.1870210715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- C M Kwan
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
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37
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Culver DL, Bezante GP, Schwarz KQ, Meltzer RS. Transesophageal echocardiography in the diagnosis of acquired aneurysms of the left atrial appendage. Clin Cardiol 1993; 16:149-51. [PMID: 8435929 DOI: 10.1002/clc.4960160214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- D L Culver
- Cardiology Unit, University of Rochester, New York
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38
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Abstract
Left atrial appendage aneurysm is a rare anomaly, which usually presents with arrhythmia or cerebral embolism. Diagnostic evaluation traditionally required cardiac catheterization, and surgical resection required cardiopulmonary bypass. Utilizing intraoperative transesophageal echocardiography and surgical stapling devices, we have streamlined our operative technique, allowing resection of a left atrial appendage aneurysm without cardiopulmonary bypass. This report of two cases treated over the past decade demonstrates the evolution of our surgical technique.
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Affiliation(s)
- R P Burke
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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39
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Comess KA, Labate DP, Winter JA, Hill AC, Miller DC. Congenital left atrial appendage aneurysm with intact pericardium: diagnosis by transesophageal echocardiography. Am Heart J 1990; 120:992-6. [PMID: 2220557 DOI: 10.1016/0002-8703(90)90226-n] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- K A Comess
- Department of Internal Medicine (Cardiology), Santa Clara Valley Medical Center, San Jose, CA 95128
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40
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Cujec B, Bharadwaj B, Orchard RC, Lopez JF. Transesophageal echocardiography in the diagnosis of left atrial appendage aneurysm. J Am Soc Echocardiogr 1990; 3:408-11. [PMID: 2245034 DOI: 10.1016/s0894-7317(14)80141-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intrapericardial left atrial appendage aneurysm is rare. We describe the transthoracic and transesophageal echocardiographic findings in a 42-year-old man with atrial arrhythmia and an abnormal left atrial appendage on chest roentgenogram. Presence of an intrapericardial left atrial appendage aneurysm was confirmed at surgery.
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Affiliation(s)
- B Cujec
- Department of Medicine, University Hospital, Saskatoon, Saskatchewan
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41
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Mohan JC, Nair M, Arora R, Khalilullah M. Congenital left atrial aneurysms: clinical characteristics and cross-sectional echocardiographic features. Int J Cardiol 1990; 26:279-83. [PMID: 2312197 DOI: 10.1016/0167-5273(90)90083-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Congenital intrapericardial aneurysm of the left atrial wall is a rare anomaly with protean manifestations. Subtle electrocardiographic and chest radiographic abnormalities often give a clue to this disease. This study describes clinical characteristics, cross-sectional and Doppler echocardiographic features of this anomaly in 4 young male patients.
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Affiliation(s)
- J C Mohan
- Department of Cardiology, G.B. Pant Hospital, New Delhi, India
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Vargas-Barron J, Sanchez-Ugarte T, Keirns C, Vazquez-Sanchez J, Fernandez-Vazquez F, Barragan R. The differential diagnosis of partial absence of left pericardium and congenital left atrial aneurysm. Am Heart J 1989; 118:1348-50. [PMID: 2686387 DOI: 10.1016/0002-8703(89)90033-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- J Vargas-Barron
- Department of Echocardiography, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico DF
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Abstract
A congenital intrapericardial aneurysmal dilatation of the left atrial wall was found in a 28 year old man who presented with atrial fibrillation after a syncopal event. The patient had cutaneous manifestations of neurofibromatosis. The diagnosis was made by cross sectional echocardiography and confirmed by angiocardiography. Surgical excision of the aneurysm resolved the symptoms.
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Affiliation(s)
- N Uren
- Regional Cardiothoracic Unit, Freeman Hospital, Newcastle upon Tyne
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44
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LaBarre TR, Stamato NJ, Hwang MH, Jacobs WR, Stephanides L, Scanlon PJ. Left atrial appendage aneurysm with associated anomalous pulmonary venous drainage. Am Heart J 1987; 114:1243-5. [PMID: 3673894 DOI: 10.1016/0002-8703(87)90206-7] [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: 01/06/2023]
Affiliation(s)
- T R LaBarre
- Section of Cardiology, Hines Veterans Administration Hospital, IL 60141
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45
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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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46
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Abstract
Congenital intrapericardial aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. One such patient who underwent aneurysmectomy is described, and the literature is reviewed.
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47
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Robinson PJ, Neutze JM, Brandt PW, Hill DG, Anderson RJ, Rutland MD. Congenital aneurysm of the left atrium: diagnosis and management. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1984; 14:267-9. [PMID: 6594119 DOI: 10.1111/j.1445-5994.1984.tb03765.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A case of congenital aneurysm of the left atrial appendage is presented and previously reported cases are reviewed. The diagnosis can be strongly suspected with the combination of an unusually prominent left heart border in the chest X-ray and two-dimensional echocardiographic findings of a large echo-free space close to the left atrium. The site of communication must be defined accurately and cardiac catheterisation and angiocardiography should be performed. Once the diagnosis is confirmed, surgery is indicated even in the asymptomatic patient because of the risk of systemic embolism.
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