Giant right atrial diverticulum with thrombus formation

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.

A Gigantic Congenital Right Atrial Appendage Aneurysm in an Infant: Ten-Year Follow-Up

A gigantic right atrial appendage aneurysm (RAAA) is a rare condition usually discovered during the third decade of life after being symptomatic. We present an asymptomatic RAAA discovered early during the basic screening of an infant and its natural history, and a ten-year follow-up due to its parents being against operation.

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.

Left atrial diverticula: Innocent bystanders or wolves in sheep's clothing?

INTRODUCTION

The finding of left atria diverticula (LAD) on cardiac computed tomography images obtained from patients with atrial fibrillation (AF) referred for pulmonary vein isolation is not uncommon. Prior studies reporting on LAD do not always provide definitions of LAD resulting in confusion with other anatomical structures such as left atrial accessory appendages (LAAA) and atrial aneurysms. The aim of this review is to identify an accurate definition of LAD and to describe distinctive properties between LAD and other left atrial structures, such as LAAA and aneurysms. Also, the relation between LAD and development of atrial tachyarrhythmias is discussed.

METHODS

PubMed was searched for studies reporting on atrial aneurysms, left atrial diverticula, left atrial accessory appendages and atrial congenital aneurysms, resulting in 36 papers.

RESULTS

LAD can be distinguished from LAAA by taking into account embryologic origins of the left atrium and their locations, resulting in the following definitions: (a) LAAA are contractile, trabeculated structures with circumscriptive ostia and narrow necks, originating from the primitive atria, (b) LAD are contractile, sac like structures with either smooth or trabeculated inner surfaces, circumscriptive ostia, narrow necks, and variable morphologies, originating from the embryologic common pulmonary vein, that incorporates into the LA, and (c) atrial aneurysms are non-contractile structures with wide necks and sac like bodies. There are no differences in prevalences of LAD between patients with sinus rhythm and AF.

CONCLUSION

The pathophysiology of LAD is not yet fully understood. It is unlikely, that LAD are related to the development of atrial tachycardia's and AF by either being a source of ectopic activity or being part of an arrhythmogenic substrate. No differences in LAD prevalences between patients with sinus rhythm and AF have been found. Thus, it is unlikely that LAD could potentially be wolves in sheep's clothing.

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.

Right atrial aneurysm with downward displacement of the anterior leaflet that resembled Ebstein's anomaly

A 13-year-old boy presented with right atrial aneurysm and downward displacement of the anterior leaflet in the tricuspid valve into the right ventricle, without tricuspid valve regurgitation. Paroxysmal atrial flutter was caused by an abnormal electrical re-entry circuit, which could not be treated using catheter radiofrequency ablation. Therefore, the patient underwent surgical ablation and resection of the enlarged right atrial wall. The anterior leaflet of the tricuspid valve was plastered and displaced downward into the right ventricle, which resembled Ebstein's anomaly. Pathological evaluation revealed a thin wall that contained fibrous tissue with lipomatous degeneration and few muscular elements. No postoperative arrhythmia was observed.