Congenital Intrapericardial Aneurysm of the Left-Atrial Appendage

Abstract

An interesting case of congenital intrapericardial aneurysm of the left-atrial appendage is reported. The patient presented with recurrent supraventricular arrhythmias and progressive exercise intolerance and fatigue. Computerised axial tomography aided in the diagnosis by excluding the presence of any thrombus in the sac. The aneurysm could be safely excised via a left thoracotomy without cardiopulmonary bypass. The relevant literature on this problem is briefly discussed.

Left Atrial Appendage Aneurysm: A Systematic Review of 82 Cases

“…2) 32,47 and atrioventricular or intraventricular conduction defects. 7,23,24,48 TTE has a limited value in the diagnosis of LAAA with a sensitivity of 45% and LAAA may be mistaken for or described as a cyst, cavity, mass, echo free structure, echolucent space, and dilated left atrium 47,[49][50][51][52][53][54] necessitating additional studies (Fig. 3).…”

Radiological signs of a left atrial aneurysm

“…Most authors recommend early surgery, particularly when progressive dilatation is present [3,11,13,14]. We hypothesize that extrapericardial aneurysms are less likely to cause complications, because the small gap through the pericardial sac might prevent embolization of thrombi; therefore, a therapy with oral anticoag-ulants might be adequate and surgical excision might not be necessary.…”

“…Such aneurysms are either congenital by partial absence of the pericardium, or acquired through mitral valve disease, syphilitic myocarditis, or tuberculosis [1,3,15]. A dissecting aneurysm of the left atrium which developed after mitral valve replacement has been identified by Maeda et al [10].…”