Off-Pump Excision of Left Atrial Appendage Aneurysm: A Case Report

Abstract

Isolated congenital intrapericardial aneurysm of the left atrium (LA) or the left atrial appendage (LAA) is a rare anomaly [Zhao 1999]. The patient usually presents with features of systemic embolization, serious arrhythmia, and severe congestive cardiac failure as a complication, which can be fatal. Once the condition is diagnosed, surgery is indicated [Zhao 1999]. We report a case of congenital left atrial appendage aneurysm in a woman who underwent excision of the same.

Left Atrial Appendage Aneurysm: A Systematic Review of 82 Cases

“…64,65 A median sternotomy approach with or without cardiopulmonary bypass or minimal endoscopic techniques are both acceptable options. 22,32,66 More than 83% of the patients in this review underwent surgical treatment. As the manipulation of aneurysm during surgery may dislodge thrombi, cardiopulmonary bypass is instituted if preoperative or intraoperative echocardiogram shows a thrombus or a large LAAA.…”

Congenital Left Atrial Appendage Aneurysm: A Case Report and Brief Review of Literature

“…It provides a safety excision in a motionless field and precludes embolisation [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][19][20][21][22][23]. Despite the report of some investigators [24,25] on the use of left lateral thoracotomy without CPB and by Burke and associates [9] on stapling of the aneurysm, we consider these techniques as risky procedures.…”

Congenital aneurysm of the left atrial wall

“…This is in contrast to the treatment of appendage aneurysms, which can typically be amputated without circulatory support, especially in patients with isolated aneurysmal dilatation of the left atrial appendage or a narrow‐necked aneurysm of the left atrial wall . In reported cases of appendage aneurysm, various successful approaches to aneurysmectomy have been described, including median sternotomy, left thoracotomy, and minimally invasive endoscopic resection, with or without CPB . Nevertheless, we believe that a median sternotomy with CPB is a better approach, especially if the aneurysm is torn or ruptured or if the base of the resection is difficult to expose or manage.…”