Congenital intrapericardial aneurysmal dilatation of the left atrial appendage

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.

Left atrial appendage aneurysm: a systematic review of 82 cases

BACKGROUND

Aneurysm of the left atrial appendage is rare. We sought to systematically review the published literature on left atrial appendage aneurysm (LAAA) to address its demographic features, clinical characteristics, treatment, complications, and outcomes.

METHODOLOGY

A systematic electronic search of Medline, PubMed, and EMBASE for case reports, case series, and related articles of LAAA published from 1962 until July 2013 was carried out. Statistical analysis was done using SPSS version 20.0. Logistic Regression Analysis was used to identify the independent predictors of LAAA-related thrombus formation and embolism.

RESULTS

Eighty-two cases of LAAA were identified. There was a slight female preponderance and most of the patients presented in their third decades. Palpitation, dyspnea or both were most common clinical symptoms associated with LAAA. Echocardiography was the main diagnostic modality used and the mean size of aneurysm was 7.08 ± 3.03 × 5.75 ± 2.36 cm. Surgical resection of the aneurysm was performed in most patients with favorable results. Systemic embolism and atrial tachyarrhythmias were the two common complications associated with untreated LAAA. Presence of atrial fibrillation/flutter was the only significant predictor of thrombus formation/embolic events.

CONCLUSION

Aneurysm of left atrial appendage is rare and often an incidental diagnosis during echocardiography. It is important to recognize this entity since it is associated with cardiovascular morbidity and mortality by predisposing to atrial tachyarrhythmia and thromboembolism. Surgical resection is the standard of treatment in the current literature. Medical management is directed toward the treatment of thromboembolism and atrial tachyarrhythmia.

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

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.

Giant left atrial appendage aneurysm: the third ventricle!

The giant congenital intrapericardial aneurysmal dilatation of the left atrial appendage without mitral valve disease is a very rare condition that is generally diagnosed in older patients. The problem is usually accompanied with supraventricular rhythm disorders and life-threatening systemic thromboembolism. Complete surgical correction is possible, and it should be performed immediately after the diagnosis. We are going to describe a patient with a history of cerebral thromboembolism and palpitation who was diagnosed with congenital intrapericardial aneurysmal dilatation of the left atrial appendage. The condition was identified by means of echocardiography and was surgically treated by resection of the appendage containing the aneurysm.

Congenital intrapericardial aneurysm of the left atrial appendage

Congenital aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. It represents a diagnostic dilemma in patients with cardiomegaly and is commonly associated with supraventricular arrhythmias and life-threatening systemic embolization. We describe the diagnostic evaluation and surgical treatment during 1997 of a patient with congenital aneurysmal dilatation of the left atrial appendage. The patient was discharged previously from our hospital in 1967 with the diagnosis of congenital dilatation of the pulmonary artery.

Congential giant aneurysms of the left atrial appendage: diagnosis and management

Giant congenital intrapericardial aneurysms of the left atrial appendage and body are unusual cardiac anomalies. Only 48 cases have been previously reported in the literature, with the vast majority presenting in otherwise healthy young patients. These can present clinically with persistent arrhythmias and progress to stroke if not diagnosed and treated. Our index case is that of a 34-year-old woman discovered to have a giant left atrial aneurysm who developed intermittent palpitations with sinus tachycardia. We present a review of the literature pertaining to their diagnosis, potential morbidity, and surgical management.

Multiple congenital aneurysms of the atria

Aneurysms of both the left and right atria are very rare congenital abnormalities. A 3-year-old boy underwent operation with preoperative diagnosis of aneurysms of both atria and supraventricular tachyarrhythmia. The multiple aneurysms were resected during cardiopulmonary bypass. The patient was asymptomatic after operation and has maintained sinus rhythm.

Congenital left atrial aneurysm in an infant

Congenital left atrial aneurysm, without associated cardiac abnormalities, is a rare defect. We report the case of a large left atrial aneurysm filling almost the entire left hemothorax. This is the first report of this anomaly occurring in an infant less than 1 year of age.