Left Atrial Appendage Aneurysm

Left atrial appendage aneurysm: a descriptive systematic review of 177 cases

INTRODUCTION

The left atrial appendage (LAA) is a distinct structure with unique developmental and structural characteristics. The LAA is involved in the formation of intra-atrial thrombi, particularly in patients with conditions such as atrial fibrillation and mitral valve disease. Left atrial appendage aneurysms (LAAA) are rare abnormal dilations of the LAA that may cause hazardous complications. However, there are limited data on the demographic features, clinical characteristics, management modalities, and prognosis of LAAA patients. This study aimed to conduct a systematic review of the reported cases of LAAA to explore the baseline characteristics, presentation, preferred diagnostic modalities, and optimal management of LAAA.

METHODS

A systematic review was conducted following the PRISMA guidelines. We performed a literature search using MEDLINE/PubMed and Google Scholar. Eligible articles published between January 1940 and November 2022 were included. The eligibility criteria included case reports and case series of LAAA in English language articles. The data extracted included information on the authors, publication year, patient characteristics, signs/symptoms, diagnostic procedures, treatments, and outcomes.

RESULTS

We identified 177 patients with LAAA in our study. There was a slight female predominance (50.9%), and the mean age was 29.7 years. Palpitations were the most common symptom reported, followed by shortness of breath and thromboembolic events. Transthoracic and transesophageal echocardiograms were the most common modalities for investigating and diagnosing LAAA, and the mean size of the aneurysm was 7.8 (5.7-9.6) × 5.9 (5.0-6.2) cm. Surgical resection is the treatment of choice for most patients with excellent prognoses. Older age and the presence of arrhythmia were significantly associated with thrombus formation and embolic events.

CONCLUSION

Left atrial appendage aneurysm is a rare but potentially life-threatening heart pathology that can lead to arrhythmias and thromboembolic events. Surgical resection appears to be the primary treatment option in the current literature, and most patients show improvement or are asymptomatic after treatment. Additionally, alternative approaches, such as transcatheter closure of LAAA, ablation, and medical treatments, have been reported as viable alternatives to surgical intervention.

Imaging reveals a fifth heart chamber: Diagnosing and treating a massive left atrial appendage aneurysm

In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.

Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report

A left atrial appendage aneurysm (LAAA) is a rare congenital or acquired anomaly that often causes fatal complications. Although many reports recommend surgical resection for treatment, there is no clear definition of LAAA. Therefore, the diagnosis and treatment are ambiguous. A 73-year-old woman with cardiogenic stroke was admitted to our hospital because of a suspected LAAA as the source of the embolus. She was incidentally diagnosed with LAAA seven years ago, which was managed with continuous anticoagulation therapy, although atrial fibrillation was not observed. The patient underwent aneurysm resection, and the postoperative course was uneventful.As LAAA symptoms are nonspecific, careful observation is required when LAAA is suspected. The risks associated with surgery are generally low and the surgical outcome is good; however, even with appropriate medical therapy, fatal complications can occur. Therefore, surgical resection of the LAAA should be considered even in asymptomatic patients, considering the low surgical risk.

Diagnosis of a giant left atrial appendage aneurysm by contrast-enhanced echocardiography: Case report and literature review

Left atrial appendage aneurysm (LAAA) is a rare pathologic entity that can be congenital or, more frequently, acquired. Its complications include arrhythmias and thromboembolic events, palpitations, hiccups, chest pain, dyspnea, and myocardial infarction. LAAA can be isolated or associated with other congenital anomalies such as atrial septal defect, ventricular septal defect, anomalous renal artery, Noonan syndrome, and Hurler-Scheie syndrome. We report a rare case of giant LAA with intra-aneurysmal thrombus diagnosed by contrast-enhanced echocardiography.

Safe treatment of congenital left atrial appendage aneurysm using lateral thoracotomy on a 3-year-old patient

Limited literatures report the management of congenital left atrial appendage aneurysm (LAAA) which is extremely rare. Chest X-ray firstly showed an enlarged left cardiac silhouette for a 3-year-old patient with pneumonia. Echocardiography and magnetic resonance imaging confirmed a large cyst attached to the left atrium. Aneurysmectomy was performed through lateral thoracotomy using step-by-step method and under the guidance of transoesophageal echocardiography. We aim to show the safety and efficacy of this approach applied to children associated with congenital LAAA.

Expansion of a Huge Compressive Left Atrial Appendage Aneurysm in a 29-Day-Old Infant

We report a case of symptomatic and progressive enlargement of a huge left atrial appendage aneurysm in a 29-day-old infant. The aneurysm was detected by fetal echocardiography and exertional dyspnea developed during the neonatal period. The aneurysm was successfully resected by decompressing the aneurysm using cardiopulmonary bypass without cardiac arrest. Our findings suggest that fetal echocardiography enables early diagnosis of the rare left atrial appendage aneurysm, and early surgical resection may protect affected patients from life-threatening symptoms.

Morphologic and functional features of left atrial appendage in Iranian population: an echocardiographic study

Introduction: Cardioembolic events are accompanied by left atrial appendage (LAA) in patients suffering from atrial fibrillation (AF); therefore, the LAA closure is implemented as a preventive strategy. The detection of LAA morphologies and function is a paramount step before establishing the LAA closure. Herein, we sought to determine the morphologic features of the LAA in an Iranian population using echocardiographic evaluation.

Methods: Seventy-two near-normal heart patients were investigated by conducting a cross-sectional study. All patients were examined using the 2-dimensional and 3-dimensional transesophageal echocardiography (2D- and 3D-TEE) method. The anatomical features and functions of LAA were examined. All images were stored and analyzed offline.

Results: The patients’ mean age was 39 ± 15.5 year and 33 (45.8%) were female. The most frequent shape of LAA was wind sock . More LAA lobes was observed in patients with AF compared to those with NSR. In comparison with AF group, the NSR had higher LAA flow velocity (P < 0.01). The paroxysmal AF had greater LAA flow velocity and LAA ejection fraction in comparison with the chronic AF (39 ± 19 vs. 75 ± 22, P < 0.01; and 49±4 vs. 72±14, P < 0.003; respectively). The paroxysmal AF had smaller systolic LAA orifice area in comparison with the chronic AF (P < 0.02).

Conclusion: The morphologic features of LAA in Iranian population were within the range of other studies and LAA length and orifice diameters in 2D- and 3D-TEE were consistent. In addition, AF influenced the morphologies and functions of LAA compared to sinus rhythm.

Resection of left atrial appendage aneurysm and full maze procedure as curative management for stroke recurrence

Left atrial appendage aneurysm (LAAA) is a rare congenital heart anomaly that frequently becomes apparent after middle age. We report a case of LAAA in a 63-year-old woman with stroke. After stabilization of ischemic cerebral stroke, the patient underwent left atrial appendectomy with full maze procedure and tricuspid annuloplasty under cardiac arrest with cardiopulmonary bypasss. She has been living a healthy life without anticoagulants postoperatively. Resection and the full-maze procedure is an efficacious and durable procedure for LAAA with chronic atrial fibrillation.

Left Atrial Appendage Aneurysm Characterized by Multimodal Imaging

We present a four-year-old female with an incidental finding of a congenital left atrial appendage aneurysm who underwent surgical resection with excellent results. This case highlights the importance of multimodal imaging in the diagnosis and characterization of this rare condition.

Five chambered heart: case of a huge left atrial appendage aneurysm

Aneurysmal enlargement of the left atrial appendage is an extremely rare pathology and can predispose to adverse events, including cardiac arrest, respiratory distress, arrhythmia, heart failure, systemic thromboembolism, or rupture. It is usually diagnosed incidentally or after the occurrence of atrial tachyarrhythmias or thrombotic events in the second to fourth decades of life. We describe a rare case of a symptomatic giant congenital left atrial appendage aneurysm (LAAA) in a 26-year-old man presenting with neurologic event, in whom surgical resection of the aneurysm was successfully performed. This is the largest LAAA reported in the literature so far.