Congenital giant aneurysm of the left atrial appendage in an infant

Abstract

Aneurysm of the left atrial appendage is a rare pathological condition. We describe the diagnostic work-up and surgical management of a child with giant congenital aneurysm of the left atrial appendage. C ONGENITAL LEFT ATRIAL APPENDAGE ANEURYSM IS a very rare congenital heart disease, 1-7 with potentially lethal complications. 1-3 We report a case of congenital left atrial appendage giant aneurysm, leading to left ventricular compression and progressive mitral valve regurgitation, which was successfully operated off pump by means of surgical excision. Case reportA 3-month-old girl, with a body weight of 6.2 kilograms was referred to our department for surgical management of a giant compressive aneurysm of the left atrial appendage. The child was asymptomatic at birth, but a cardiac murmur was detected at routine physical examination. The chest roentogenogram showed a nonspecific cardiomegaly with an unusually prominent left heart border. Electrocardiogram showed regular sinus rhythm, with a heart rate of 146 beats per minute, and no episodes of arrhythmia or thromboembolism were ever reported. Soon after birth, a two-dimensional cross-sectional echocardiographic and Doppler examination revealed a large aneurysm of the left atrial appendage (45 3 60 millimetres), communicating with the left atrium through a large orifice (Fig 1).The patient was followed up clinically by serial echocardiographic examinations that showed progression of mitral regurgitation from mild to moderate. In addition, when compared with the first assessement, the most recent echocardiographic detections showed that the left ventricle was rightwardly dislocated, as if the enlarged atrial appendage was pushing on it. Thus, because of echocardiographic evidence of left ventricular dislocation and Figure 1. Two-dimensional echocardiographic four-chamber view, showing the giant aneurysm originating from the left atrium (RA 5 right atrium; RV 5 right ventricle; LV 5 left ventricle; LA 5 left atrium, LAA 5 left atrial appendage; arrow pointing at the LAA aneurysm).

Giant Left Atrial Appendage Aneurysm in a Neonate

“…[2][3][4][5] As in our patient, two of the four cases were detected on fetal echocardiography and confirmed at birth [4][5] ; the others were diagnosed at 3 and 18 months of age, following the investigations of a murmur and distant heart sounds, respectively. 2,3 All infants were initially asymptomatic at birth except one who demonstrated mild respiratory distress. 5 To our knowledge, no previous reports of congenital giant LAA aneurysms have discussed noninvasive imaging with cardiovascular magnetic resonance (CMR).…”

A rare giant congenital left atrial appendage aneurysm in a 1‐day‐old newborn

“…These patients may be asymptomatic and/or may present with dyspnea, palpitations, and thromboembolic events . The most common complications are life‐threatening thromboembolic events and supraventricular tachyarrhythmias . Transthoracic echocardiography plays a very important role in the diagnosis of LAAA; in addition to the absence of pericardial defect, there is a direct link between the aneurysm and the normal left atrial space.…”

Combination of congenital left atrial appendage aneurysm in an infant with transposition of the great arteries: a previously unreported association

“…Congenital left atrial appendage aneurysms are caused by congenital dysplasia of the atrial muscle 1 . These aneurysms probably increase in size as the patient ages 2 . Despite its congenital cause, symptoms usually do not arise until the second or third decade of life 1…”

“…1 These aneurysms probably increase in size as the patient ages. 2 Despite its congenital cause, symptoms usually do not arise until the second or third decade of life. 1,3 Once the aneurysms reach a larger size, they predispose the patient to supra-ventricular arrhythmias, cardiac dysfunction, atypical chest pain episodes due to compression of the left coronary artery or any of its divisions, an increased risk of intra-atrial thrombus formation, and systemic embolisation.…”