Surgical management of an aneurysm of the left atrial appendage to prevent potential sequelae

Abstract

An aneurysm of the left atrial appendage is an extremely rare anomaly that is commonly associated with supraventricular arrhythmia, compression of the coronary arteries, intracardiac thrombus and pulmonary venous stenosis. This condition may be caused by congenital dysplasia of the musculi pectinati and is usually diagnosed in the second to fourth decades of life. We report the surgical management of an asymptomatic 9-year old girl with this anomaly. She was referred to us because of abnormal chest X-ray findings, and investigation revealed an aneurysm of the left atrial appendage. As this condition may have potentially fatal complications, the aneurysm was completely resected under cardiac arrest with cardiopulmonary bypass to prevent recurrence and thrombus formation. We suggest that resection of an aneurysm of the left atrial appendage under cardiac arrest with cardiopulmonary bypass is a reasonable treatment option to prevent potential complications, particularly in children.

Aneurysm left atrial appendage

“…However arrhythmias in most patients tend to disappear in the immediate postoperative period. [4,11,12]. …”

Cardiac Vignette: Giant Left Atrial Appendage Aneurysm

“…Other imaging modalities such as CT scans, MRI, Radionuclide Scintigraphy, and Angio-cardiography can also be used to supplement the findings on transthoracic echocardiography [1,6]. These investigations are often useful in confirming and further characterising the defect, in addition to differentiating it from separate but clinically relevant conditions, such as mediastinal neoplasms, pericardial abnormalities, anomalous pulmonary vasculature and secondary causes of left atrial enlargement (such as valvular heart disease) [6].…”

“…These investigations are often useful in confirming and further characterising the defect, in addition to differentiating it from separate but clinically relevant conditions, such as mediastinal neoplasms, pericardial abnormalities, anomalous pulmonary vasculature and secondary causes of left atrial enlargement (such as valvular heart disease) [6].…”

“…Surgical resection involves an aneurysmectomy, which can be performed via median sternotomy aided with cardiopulmonary bypass, or left lateral thoracotomy approach with intra-operative transoesophageal echocardiogram (without cardiopulmonary bypass) [6,7]. Each surgical approach has its merits, with the prior procedure having the burden of increased invasiveness, offset by better suitability for removal of large aneurysms with associated thrombus [6,7].…”

“…Each surgical approach has its merits, with the prior procedure having the burden of increased invasiveness, offset by better suitability for removal of large aneurysms with associated thrombus [6,7]. Recently, minimally invasive endoscopic resection has been demonstrated to be a safe and effective surgical alternative to aneurysmectomy.…”