Giant Right Atrial Aneurysm: Antenatal Diagnosis and Surgical Treatment

Abstract

Giant congenital right atrial aneurysms are rare, with their natural history complicated by death, heart failure, arrhythmias, and thrombosis. Prenatal diagnosis of the defect is feasible and allows an early preparation of a plan for management. We present details of a patient diagnosed prenatally with a giant right atrial aneurysm, which was successfully treated surgically as soon as the patient became symptomatic.

Clinical Presentation, Diagnosis, and Management of Idiopathic Enlargement of the Right Atrium: An Analysis Based on Systematic Review of 153 Reported Cases

“…Some researchers believe IERA as a benign condition not affecting life expectancy [7, 35], but others suggested its complications were life-threatening, including refractory arrhythmias, RHF, thromboembolic events, and sudden death [6, 34, 36]. This review found 4 sudden cardiac deaths due to refractory atrial tachycardia or RHF in 153 IERA patients.…”

“…For asymptomatic patients, some clinicians suggested prophylactic resection to avert possible complications [4, 26, 43, 44]. Others, however, suggested a watchful waiting in combination with regular follow-up [6]. Some patients responded well to the surgical treatment while others were more responsive to the nonsurgical approach [3, 10].…”

“…Although this condition is asymptomatic in most cases, some cases might present with arrhythmias, airway obstruction, heart failure, and thromboembolic events [1-4]. The mortality of the condition reportedly stood somewhere at 5% [5, 6]. However, studies on its clinical features, diagnosis, treatment, and prognosis are limited, without consensus about its management, including prophylactic aneurysmal resection and the conservative treatment, since only sporadic cases were reported.…”

Isolated Congenital Right Atrial Aneurysm: Monitoring Parameters for Asymptomatic Patients

“…9 In general, the risk of operative mortality is low but not zero, and is higher for the youngest patients. 2,10 This age effect is seen in pediatric heart surgery in general, even in operations of relatively low complexity. Caution has been urged against RAA resection without cardiopulmonary bypass 6,10,11 and against rushing into elective open-heart surgery before three years of age.…”

“…But monitoring with serial ECG, Holter, and echocardiograms will identify events, which are usually not life-threatening in asymptomatic patients and amenable to medical therapy and RAA resection. 10…”