Congenital aneurysm of 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 Case Report and Literature Review

The left atrial appendage aneurysm is an uncommon condition that has garnered attention from the medical community due to its low incidence and varied clinical manifestations. The difficulty in identification is reflected in its incidental detection in imaging studies such as echocardiograms and tomographies, while symptoms range from mild to severe, including heart failure and thromboembolic events. The complex etiology includes congenital and acquired factors, and its management focuses on preventing complications through surgical resection, accompanied by medical strategies such as controlling heart rhythm and anticoagulation. The case of a 67-year-old woman with significant medical history illustrates these challenges. Despite an inconclusive initial diagnosis, a tomography revealed an aneurysm with an intracavitary thrombus, leading to successful surgical resection. However, subsequent infectious complications resulted in her death. The average age of diagnosis is around 30 years, and while it is more common in women, there are no significant gender differences. Surgical management remains the preferred option, especially in severe cases, although in some patients, a watchful waiting approach is chosen. In conclusion, the left atrial appendage aneurysm is a complex entity that requires a multidisciplinary approach to improve clinical outcomes. Early diagnosis and appropriate treatment are crucial to prevent serious complications and improve the quality of life of affected patients.

Left atrial appendage aneurysm in pediatrics: Case study and literature review

Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.

Surgical resection of a left auricular aneurysm in a dog

Aneurysmal dilation of the atrial appendage (auricle) is rare in humans and dogs. Congenital and acquired etiologies are hypothesized. Although right auricular aneurysm has been described in dogs, this is the first case report of an aneurysm of the left auricle of a dog with an intact pericardium. In humans, because complications of arrhythmia and thromboembolic disease have been reported, surgical resection of left auricular aneurysm is recommended. This report describes the successful surgical resection of a left auricular aneurysm in a dog, including a one-year follow up. Surgical resection can be considered in dogs with auricular aneurysm.

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.

Congenital left atrial appendage aneurysm: A rare case report and literature review

RATIONALE

Left atrial appendage aneurysms (LAAA) are rare. Patients with LAAA are often diagnosed incidentally or after cardiac tachyarrhythmia or systemic thromboembolism happen. Early diagnosis and surgical resection is of utmost importance to prevent hazardous adverse events.

PATIENT CONCERNS

We present a case of 46-year-old man with congenital LAAA. The individual in this manuscript has given written informed consent to publish these case details.

DIAGNOSES

Imaging studies, such as echocardiography, cardiovascular computed tomography (CT) and magnetic resonance imaging (MRI), demonstrated the large cavity arising from the left atrial appendage. The diagnosis of LAAA was confirmed.

INTERVENTIONS

The patient underwent an aneurysmectomy without any complications.

OUTCOMES

TTE confirmed the disappearance of the LAAA from the left parasternal short-axis view of the aortic root postoperatively. The patient remained asymptomatic without any adverse events at his 3-month follow-up visits.

LESSONS

The associated high risk of life-threatening complications and the relative ease of surgical removal suggest that prompt evaluation should be considered in patients with lesions adjacent to the left heart border.

Congenital giant left atrial appendage aneurysm: a case report

BACKGROUND

Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with potentially serious complications, including life-threatening systemic thromboembolism, atrial tachyarrhythmia, and cardiac dysfunction. Currently, early surgical intervention is generally recommended to prevent these complications.

CASE PRESENTATION

We present a case of congenital giant LAAA in a female patient who successfully completed pregnancy and underwent caesarean section with no obvious complications. Surgical resection of the LAAA was performed 3 years later, at the onset of chest pain resulting from compression of adjacent cardiac structures by the LAAA.

CONCLUSION

Surgical resection is recommended for the majority of patients with LAAA because of potential LAAA-related severe outcomes. However, clinical monitoring may be an optional strategy for asymptomatic patients without intra-atrial thrombus or other complications. Precise evaluation with echocardiography and brain magnetic resonance imaging is valuable for the subsequent management of LAAA.

Congenital Intrapericardial Left Atrial Aneurysm

A 14-year-old boy with sudden onset of palpitations and dyspnea was found to have an intrapericardial left atrial aneurysm (15 × 12 cm). Left atrial aneurysmectomy was carried out under cardiopulmonary bypass. The patient has been symptom-free during a 1-year follow-up.

Left Atrial Appendage Ligation And Exclusion Technology In The Incubator

Stroke is the most feared complication of atrial fibrillation (AF). Targeting the left atrial appendage (LAA) mechanically is attractive as a means to simultaneously reduce stroke risk, the need for anticoagulation, and hemorrhagic complications in patients with non-valvular AF. The results of the PROTECT-AF and PREVAIL randomized clinical trials support this approach as a viable therapeutic alternative to warfarin in selected patients and add to accumulating evidence regarding the importance of the LAA in thromboembolism in AF. A number of devices for percutaneous LAA closure are under investigation or development. In this article, key design features of these ligation and exclusion technologies will be discussed, with a focus on aspects of LAA morphology, relational anatomy, thrombosis, and thromboembolism relevant for successful device development and deployment.

Left atrial appendage exclusion for atrial fibrillation

Percutaneous left atrial appendage (LAA) closure is being increasingly used as a treatment strategy to prevent stroke in patients with atrial fibrillation (AF) who have contraindications to anticoagulants. Several approaches and devices have been developed in the last few years, each with their own unique set of advantages and disadvantages. In this article, the published studies on surgical and percutaneous approaches to LAA closure are reviewed, focusing on stroke mechanisms in AF, LAA structure and function relevant to stroke prevention, practical differences in procedural approach, and clinical considerations surrounding management.

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.

Giant left atrial appendage: a rare anomaly

A giant left atrial appendage is a rare congenital anomaly that has been reported on only a few occasions. We report two symptomatic patients with atrial fibrillation combined with a cerebellar infarct in one and dyspnea in the other. Both patients were treated surgically with resection of the giant left atrial appendage and radiofrequency pulmonary vein isolation. Recognition of this uncommon pathology can lead to timely surgical intervention.

The role of cardiac magnetic resonance imaging in the evaluation of congenital pericardial defects

Pericardial defects are rare congenital anomalies that result from failure of the pericardium to form properly during embryogenesis. In this article, we present a case of a patient with persistent atrial fibrillation who underwent a multimodality imaging evaluation that included cardiac magnetic resonance imaging. Our patient demonstrated secondary signs of a partial defect that was not directly visualized on imaging and was ultimately diagnosed during open surgical intervention. This case illustrates that a high level of suspicion should be maintained for patients who demonstrate secondary imaging findings that suggest the presence of an underlying pericardial defect. Magnetic resonance imaging is the preferred modality for evaluating the pericardium, because of its ability to image the heart in any plane, improved soft tissue contrast compared with computed tomography, and lack of radiation exposure to the patient. However, direct visualization may be limited by patient-specific factors, such as paucity of pericardial fat and the size and location of the defect. In such cases, surgical evaluation may be necessary.

A giant left atrial appendage aneurysm with a large pinball-like thrombus in a 2 year old

Congenital left atrial appendage aneurysm is very rare. We describe a giant left atrial appendage aneurysm with a pinball-like mobile thrombus in a 2-year-old child with cardioembolic stroke. Patient underwent successful surgical resection of the aneurysm.

Congenital giant aneurysm of the left atrial appendage in an infant

Aneurysm of the left atrial appendage is a rare pathological condition. We describe the diagnostic work-up and surgical management of a child with giant congenital aneurysm of the left atrial appendage.

Congenital left atrial appendage aneurysm: a case report and brief review of literature

A 28-year-old woman with congenital aneurysm of the left atrial appendage was successfully treated by aneurysmectomy and is reported for its rarity. The exact diagnosis is relatively easy to make by contrast echocardiography, magnetic resonance imaging, and/or computerised tomographic angiography, provided the possibility is entertained. Because of supraventricular arrhythmias and systemic thromboembolism, surgical resection was deemed the best curative option to avoid further episodes and recurrence. Published reports detailing the diagnostic evaluation and surgical management for congenital left atrial appendage aneurysm are also discussed.

Giant left atrial appendage with a common ventricular-appendicular wall and an abnormal course of the circumflex coronary artery in an asymptomatic 18-month-old girl

We present a congenital giant left atrial appendage in an asymptomatic 18-month-old girl featuring two morphological aspects not yet described, namely, a common wall between the giant left atrial appendage and the left ventricle and an abnormal course of the circumflex coronary artery across the surface of the grossly dilated left atrial appendage which prohibited its radical resection. Surgery was performed off-bypass, via anterolateral thoracotomy with plication of the aneurysm, leaving a residual pouch. A patch closure of the communicating os between the left atrium and the residual aneurysm was therefore undertaken later. Radical surgical resection is recommended for giant left atrial appendage if complications are to be avoided, as there is potential for progressive growth, intracardiac thrombosis, systemic embolization, cardiac arrhythmia, and need for life-long anticoagulation.

A Rare Congenital Anomaly: Biatrial Appendage Aneurysm with Atrial and Ventricular Septal Defect

Atrial appendage aneurysms are extremely rare entities in cardiology practice. There are reports of solitary left and right atrial appendage aneurysms in the literature. A case of biatrial appendages aneurysms is reported here. This is the first report of such an anomaly.

Congenital pericardial defect: report of two cases and literature review

The authors report two cases of congenital pericardial defect and emphasize the role of MRI as a diagnostic tool. A review of the development of the pericardium and of the various possible explanations dealing with these abnormalities is then presented. Finally, clinical data and diagnosis and therapeutic options are discussed.

Giant left atrial intrapericardial aneurysm: noninvasive preoperative imaging

Congenital giant intrapericardial aneurysms of the left atrium are rare. A 17-year-old boy presented with paroxysmal episodes of palpitations, chest pain, and dyspnea. A chest roentgenogram showed an enlarged left cardiac silhouette. Transthoracic echocardiography imaging showed an intrapericardial aneurysm of the left atrium. Cardiac magnetic resonance imaging confirmed the diagnosis and delineated adjacent structures to plan the surgical resection. We have found no previous reports of cases of diagnosis and preoperative assessment based solely on noninvasive imaging.

Atrial tachycardia as the presenting sign of a left atrial appendage aneurysm

A patient presented with atrial tachycardia. The work-up, guided by the tachycardia morphology, led to the diagnosis of left atrial appendage aneurysm. Surgical removal of the atrial appendage resulted in cure of the tachycardia and associated symptoms.

Silent giant left atrium. A case report

A sixty-two-year-old white woman with a 14.5 cm (145 mm) silent giant left atrial enlargement secondary probably to rheumatic heart disease is presented. Aside from mild progressive shortness of breath during the past year, the patient had been asymptomatic all her life. Her clinical picture was manifested for the first time by syncope secondary to slow atrial fibrillation, for which a permanent pacemaker was required. The correct diagnosis of the enlarged chamber was not possible through the routine chest roentgenogram. In this case, the echocardiogram, nuclear angiogram, and computed tomography were the pertinent studies needed to reach the diagnosis.

Transesophageal echocardiography in the diagnosis of left atrial appendage aneurysm

Intrapericardial left atrial appendage aneurysm is rare. We describe the transthoracic and transesophageal echocardiographic findings in a 42-year-old man with atrial arrhythmia and an abnormal left atrial appendage on chest roentgenogram. Presence of an intrapericardial left atrial appendage aneurysm was confirmed at surgery.

Congenital left atrial aneurysms: clinical characteristics and cross-sectional echocardiographic features

Congenital intrapericardial aneurysm of the left atrial wall is a rare anomaly with protean manifestations. Subtle electrocardiographic and chest radiographic abnormalities often give a clue to this disease. This study describes clinical characteristics, cross-sectional and Doppler echocardiographic features of this anomaly in 4 young male patients.

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.

Congenital diverticulum of the left ventricle presenting as heart failure and diagnosed by magnetic resonance imaging

We report a 25-year-old man with a probable congenital diverticulum of the heart. The diverticulum was clearly shown using magnetic resonance imaging.

Congenital left atrial wall aneurysm in a patient with neurofibromatosis

A congenital intrapericardial aneurysmal dilatation of the left atrial wall was found in a 28 year old man who presented with atrial fibrillation after a syncopal event. The patient had cutaneous manifestations of neurofibromatosis. The diagnosis was made by cross sectional echocardiography and confirmed by angiocardiography. Surgical excision of the aneurysm resolved the symptoms.

Congenital diverticulum of the heart arising from the coronary sinus

A diverticulum originating from the coronary sinus was diagnosed by echocardiography in a two day old baby with hypoplastic left heart. At necropsy the diverticulum was seen to arise from the coronary sinus and it penetrated the right ventricular posterior wall.

Congenital intrapericardial aneurysmal dilatation of the left atrial appendage

Congenital intrapericardial aneurysmal dilatation of the left atrial appendage is a rare but correctable lesion. One such patient who underwent aneurysmectomy is described, and the literature is reviewed.

Aneurysmal dilatation of left atrial appendage diagnosed by cross sectional echocardiography and surgically removed

An isolated aneurysmal dilatation of the left atrial appendage was found in an 18 year old girl who presented with atrial fibrillation and an unusual cardiac shadow on routine chest radiographs. The diagnosis was made by cross sectional echocardiography. The giant appendage was excised to remove the risk of systemic embolism and the need for life long anticoagulation.

Congenital aneurysm of the left atrium: diagnosis and management

A case of congenital aneurysm of the left atrial appendage is presented and previously reported cases are reviewed. The diagnosis can be strongly suspected with the combination of an unusually prominent left heart border in the chest X-ray and two-dimensional echocardiographic findings of a large echo-free space close to the left atrium. The site of communication must be defined accurately and cardiac catheterisation and angiocardiography should be performed. Once the diagnosis is confirmed, surgery is indicated even in the asymptomatic patient because of the risk of systemic embolism.

Congenital aneurysms of the left atrium: recognition by cross-sectional echocardiography

The two-dimensional echocardiographic features of three patients with congenital aneurysms of the left atrium are described. The aneurysm arose from the left atrial appendage in two patients and from the posterior left atrial wall in one. The aneurysms were characterized by their origin from an otherwise normal left atrium, a well-defined neck, their position within the pericardial space, and distortion of the left ventricular free wall by the aneurysmal body. The differentiation of these structures from other abnormalities of the left atrium are also discussed. Two-dimensional echocardiography is a safe and reliable method for diagnosing congenital aneurysm of the left atrium, and such studies should be considered in any patient with an otherwise unexplained abnormality on the chest radiograph.