Silent giant left atrium. A case report

Congenital left atrial appendage aneurysm: A rare case report and literature review

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.

Congenital aneurysm of the left atrial wall

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.

A Case of Giant Left Atrium Mimicking Pleural Effusion

Giant left atrium has become rare in present day owing to decreased incidence, earlier diagnosis and treatment of rheumatic mitral valve disease. Transthoracic ultrasonography (USG) is remarkable for clear visualization of giant left atrium with clots. Had there been no clot, USG picture could be mistaken for aortic aneurysm. In severe left atrial enlargement, chest x-ray may be mistaken for pleural/pulmonary mass or rarely pleural effusion. USG and echocardiography may help in diagnosis in such case. A 52 year old female presented with progressive respiratory distress for last two years. She had undergone mitral valve replacement (metallic valve) 24 years back for rheumatic mitral stenosis but for last eight years, she did not come for follow up and had discontinued warfarin. Chest x-ray showed a homogeneous opacity in left hemithorax with obliteration of left costo-phrenic angle suggesting pleural effusion. An USG of left hemithorax revealed a giant left atrium with spontaneous echogenicity suggesting multiple large non-organized thrombi. There was no pleural/pericardial effusion. Echocardiography also showed a giant left atrium with clots.

Reversal of hoarseness with recognition of Ortner syndrome in a patient with severe mitral regurgitation

Loss of voice due to vocal cord paralysis, as in Ortner syndrome, is secondary to left recurrent laryngeal nerve palsy. Cardiovascular cause should be listed as a differential diagnosis of hoarseness and is incumbent upon the diagnostic physician to be familiar with the condition. A 56-year-old male presented to our emergency department with shortness of breath due to severe mitral regurgitation. Incidental finding of aggravating hoarseness during the past six months was suspected to be related to his cardiac condition with hugely dilated left atrium. After an ear nose and throat specialist confirmed left vocal cord paralysis, a cardiac surgeon was consulted for surgical management. The operation consisted of mitral valve repair, tricuspid valve repair, left atrial reduction, and Cox maze procedure. Three days after surgery the patient had noticeable improvement in his voice, and 3 months later he had complete resolution of the hoarseness. Awareness of Ortner syndrome and a search for treatable cause of vocal cord palsy therefore is imperative before the nerve injury becomes irreversible. <Learning objective: Hoarseness in unusual clinical setting (i.e. other than in common cold), should raise suspicion and alert physician to search for primary cause of the symptoms. Ortner syndrome, due to left recurrent laryngeal nerve palsy secondary to cardiovascular disease, is an important differential diagnosis of loss of voice. Comprehensive evaluation and timely intervention allow reversal of the damage to left recurrent laryngeal nerve, whereas delay in diagnosis may lead to permanent nerve injury.>.

Unilateral breast oedema in a case of non-rheumatic giant left atrium

Giant left atrium (GLA) is a well-described entity in association with rheumatic heart disease. However, mitral valve prolapse is an extremely unusual cause of GLA, especially without the compressive symptoms it can often accompany. We discuss a case of a 78-year-old lady with no prior history of rheumatic heart disease with these findings with the unusual presentation of accompanied unilateral breast oedema as a manifestation of heart failure. This case illustrates the investigations and treatment options for GLA and the need for prompt assessment as it increases the risk of sudden death; therefore, its presence warrants careful evaluation and surgical intervention when appropriate.

Congenital left atrial appendage aneurysm: a case report and brief review of literature

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.

Minimal invasive endoscopic resection of a giant left atrial appendage aneurysm

We report a case of a 35-year-old male patient who presented with chronic atrial fibrillation secondary to a massive congenital left atrial appendage aneurysm. Minimal invasive endoscopic resection of the left atrial aneurysm with cryoablation was performed. The patient was discharged home in sinus rhythm.