Rupture of right coronary artery aneurysm into the right atrium

A 63-year-old man presented with acute congestive heart failure and was found to have a continuous murmur. Two years earlier, he had an inferior myocardial infarct, when no murmurs were heard. Angiography showed a right coronary artery aneurysm communicating with the right atrium. The distal vessel was occluded. The aneurysm was resected and the patient remains well. It is proposed that this was a congenital aneurysm which led firstly to the myocardial infarct and finally ruptured into the right atrium.     

Rupture of an aneurysm of the aortic sinus of Valsalva into the right ventricle. A case presenting an unusual hemodynamic manifestation

Rupture of an aneurysm of the aortic sinus of Valsalva into the right ventricle is described. Surgery revealed a small aneurysm ruptured into the right ventricle near the tricuspid valve without aneurysmal involvement of the tricuspid valve. The cineangiogram revealed a shunt from the aortic sinus into the right atrium not during systole but during diastole, and increased oxygen saturation was found in the right atrium. The unusual hemodynamics in this case was most probably due to the closure of the small aneurysmal opening due to myocardial contraction during systole, so that the shunt flow through the aneurysmal tract occurred only during diastole and was directed toward the right atrium due to the location of the aneurysm. Thus, even without aneurysmal involvement of the tricuspid valve or tricuspid regurgitation, the oxygen saturation increased in the right atrium.     

False aneurysm of the right atrium.

A false aneurysm of the right atrium is described. The false aneurysm appeared after open-heart surgery and was probably related to loosening of a right atrial suture. Because of the low pressure in the right atrium, the danger of rupture seemed to be low, and conservative therapy was chosen.     

Asymptomatic giant right atrial aneurysm.

A 5-year-old asymptomatic boy was found incidentally, on a chest radiograph, to have gross cardiomegaly; further evaluation by echocardiography showed a giant right atrial aneurysm. The patient underwent successful surgical reduction of the right atrium, closure of an atrial septal defect, and tricuspid valve repair These measures were taken to prevent thrombus formation in the right atrium, prevent paradoxical embolism, and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed paper-thin wall with a central aneurysm and focal endocardial fibrosis consistent with a diagnosis of idiopathic dilatation of the right atrium.     

Giant right atrial aneurysm: case report

A 15-month-old boy with atrial fibrillation was found to have gross cardiomegaly on a chest radiography; further evaluation by echocardiography showed a giant right atrial aneurysm which is in the form of a cyst like lesion. The patient underwent successful surgical reduction of the right atrium converting his heart rhythm to normal. The operative measure was taken to prevent thrombus formation in the right atrium and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed a thin wall with a central aneurysm and focal endocardial fibrosis without inflammatory response consistent with a diagnosis of idiopathic dilatation of the right atrium.     

Ruptured non-coronary sinus of Valsalva aneurysm into the right atrium in 44-year-old patient

We hereby present a case report of ruptured sinus of Valsalva aneurysm into the right atrium in 44-year-old patient with 8-month progressive exertional dyspnoea, occasional palpitations and oedema of lower extremities. A massive left-to-right shunt between the outflow tract of the left ventricle and right atrium was discovered from the echocardiogram examination. The patient was indicated for surgery, during which it was discovered a defect in the area of the non-coronary sinus extending into the right atrium, calcifications in the annulus of the congenitally bicuspid aortic valve, without signs of endocarditis present, abundant tissue was excised from the right atrium which had originally been an aneurysm of the non-coronary sinus of the aortic root. Sinus of Valsalva aneurysm is a very rare pathology which is generally asymptomatic. In this case it manifested through a rupture into the right atrium and symptomatology of right-sided heart failure. Surgery was the only possible treatment.     

Ruptured left sinus of valsalva aneurysm to right atrium

A 6-year-old child presented with left sinus of Valsalva aneurysm opening in right atrium. Origin of sinus of Valsalva from left aortic sinus and its opening into right atrium is extremely rare. The anomaly was corrected surgically by patch closure at the aortic end. Follow-up echocardiography did not reveal any residual shunt in right atrium.     

Post-infarction communication between a left ventricular aneurysm and the right atrium.

A 70-year-old patient presented with ventricular tachycardia and left ventricular failure. He was found to have a communication between a posterior left ventricular aneurysm and the right atrium. The causal myocardial infarction had been silent. This defect was satisfactorily closed at operation from which he made an uneventful recovery. This is the first report of a left ventricular-right atrial communication developing in association with ischaemic heart disease and highlights the role of transoesophageal echocardiography in the diagnosis and surgical management of such a condition.     

Rupture of an aortic dissection into the right atrium in a patient with a previous aortic valve replacement: a case report.

We report the case of a 73-year-old man with a history of previous aortic valve replacement in 1990 and rupture of an aortic dissection into the right atrium. The patient was admitted to the emergency room because of chest pain, stopped not long after. The electrocardiogram did not show any signs of ischemia and myocardial enzymes were not increased. Transthoracic echocardiography revealed aortic root dilation (maximum diameter 60 mm) extended to the aortic arch, and the presence of a flow from the ascending aorta to the right atrium (evocative of a fistula between the two chambers). The aortic valvular prosthesis function was good. Transesophageal echocardiography confirmed an aorta-right atrium fistula. Cardiac catheterization did not show any luminal obstructions in the coronary arteries; there was a small shunt from the aorta to the right atrium. The ascending aorta and the aortic root were replaced with a Dacron graft. Right and left sinuses were reimplanted to the graft. The fistula was repaired with 4-0 pledgeted Prolene sutures. The surgeon's diagnosis was "type A aortic dissection in a patient with an ascending aorta aneurysm and an old ascending aorta-right atrium fistula".     

Giant interatrial septal aneurysm mimicking a right atrial tumor

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.     

Aortic aneurysm mimicking a right atrial mass

We present a case of a 54‐year‐old female who was initially thought to have a cystic mass in the right atrium on two‐dimensional transthoracic echocardiography. Careful transducer angulation and off‐axis imaging showed this mass‐like effect was produced by an aortic root aneurysm impinging on the right atrium.     

Colossal left main to right atrium fistula ligation complicated by left circumflex STEMI

Congenital left main (LM) coronary artery to right atrium fistulas with progression to aneurysm development are rare. Most patients remain asymptomatic, but for those with progressive symptoms, intervention is required. However, there are potential life-threatening complications associated with surgical intervention. We present a case of an extremely rare markedly aneurysmal LM to right atrial fistula treated with surgical ligation complicated by inferolateral ST-elevation myocardial infarction several days post-operatively treated successfully using mechanical aspiration thrombectomy, a stent-retriever, balloon angioplasty, and subsequent intravascular ultrasound-guided percutaneous coronary intervention with drug-eluting stent.     

Premature pulmonic valve opening following sinus of Valsalva aneurysm rupture into the right atrium.

Echocardiographic features of a patient with sinus of Valsalva aneurysm rupture into the right atrium are described. The aneurysm presented as a dense echo-producing mass in the right atrium which descended into the tricuspid orifice during diastole and withdrew back into the atrium during ventricular systole. Pulmonic valve exho motion demonstrated early diastolic pulmonic valve opening indicating an early right ventricular diastolic pressure rise exceeding simultaneous pulmonary artery pressure. Since the aorta is the only source of early diastolic pressure in excess of pulmonary artery pressure available to the right heart, this finding of early diastolic pulmonic valve opening indicated the presence of a fistula between the aorta and right heart. Other interesting echocardiographic features of this case are also presented.     

Left atrial pressure gradient and right heart failure secondary to compression of the left atrium by a huge ascending aortic aneurysm: a case report

A 71-year-old man was admitted to our department with congestive heart failure on June 28, 1998. He previously had an aortic valve replacement because of aortic regurgitation probably due to annuloaortic ectasia in 1984. Thoracic aortic aneurysm was identified during the postoperative course. Magnetic resonance imaging showed a huge saccular ascending aortic aneurysm of 12 x 11.5 x 9.5 cm size, which had severely compressed the left atrium. Doppler echocardiography documented an accelerated flow (2.2 m/sec) in the left atrium in early diastole. The calculated pressure gradient was 19 mmHg. All pressures in the right heart system were elevated. This is the first case of pulmonary hypertension and right heart failure secondary to compression of the left atrium in a patient with thoracic aortic aneurysm.     

Vascular aneurysm producing divided right atrium in a patient with pulmonary atresia and intact ventricular septum

We describe a patient with pulmonary atresia and intact ventricular septum in whom the right atrium was divided by a vascular aneurysm located in the right atrioventricular groove. We postulate that the structure represents an aneursymally dilated right coronary artery taking anomalous origin from the pulmonary trunk, with fistulous communication to the right atrium. We discuss the findings relative to concepts of development of the coronary arteries in normal hearts and in pulmonary atresia with an intact ventricular septum.     

Left-circumflex coronary artery to right atrium fistula with saccular aneurysm and its endovascular treatment

The combination of coronary artery aneurysm and coronary artery fistula is infrequent. A saccular aneurysm of a branch of the left-circumflex coronary artery associated with multiple fistulae to the right atrium was observed on a coronary angiogram performed in a 47-year-old female. Multidetector computed tomography coronary angiography detailed the anatomy of the abnormal coronary artery. An embolization with a microcoil was performed and the aneurysm sac was excluded.     

Echocardiographic diagnosis of atrial septal aneurysm in an infant with hypoplastic right heart syndrome

Echocardiographic findings are described in a patient with hypoplastic right heart syndrome (pulmonary atresia type with intact ventricular septum and small right ventricular cavity) who had an associated atrial septal aneurysm. An unusual appearance of echoes behind the aorta bulging into the left atrium in diastole on both the M-mode and cross-sectional echo suggested this diagnosis prior to cardiac catheterization. The angiographic findings confirmed the diagnosis of right ventricular hypoplasia, pulmonary atresia and the large atrial septal aneurysm. The infant died after surgery and the atrial septal aneurysm was observed at autopsy. The importance of the diagnosis of the atrial septal aneurysm and its association with restriction of right-to-left atrial shunting prompts this report.     

Ruptured saphenous vein graft aneurysm after aortocoronary bypass grafting

Computed tomography demonstrated a giant saphenous vein graft aneurysm that compressed the right atrium of a 72-year-old woman 20 years after undergoing coronary artery bypass grafting. Angiography revealed contrast medium leakage in the mid-portion of the graft aneurysm. Aneurysmectomy was performed without repeat grafting. Postoperative myocardial scintigraphy demonstrated no significant myocardial ischemia. The ischemic effect of non-revascularization should be considered preoperatively because of the difficulties with repeat grafting.     

Two-dimensional and Doppler echocardiographic diagnosis of an aortic to right atrial fistula complicating aortic dissection

A 60 year old woman presented with massive aortic root dilation and sudden cardiovascular collapse 10 years after aortic valve replacement. An aortic to right atrial fistula was diagnosed by echocardiographic imaging and Doppler ultrasound. At operation, the patient was found to have chronic aortic dissection with aneurysm formation. Rupture of the aneurysm into the right atrium was confirmed.     

Unruptured sinus of Valsalva aneurysm mimicking as right atrial tumor

Sinus of Valsalva aneurysm is a rare congenital cardiac abnormality and is usually diagnosed when it ruptures. An asymptomatic 55‐year‐old male of unruptured sinus of Valsalva aneurysm of noncoronary cusp was on medical follow‐up. At 2‐year follow‐up, there was thrombus formation in the aneurysm, mimicking right atrium tumor on 2D transthoracic echocardiography. Cardiac computed tomography showed filling defect in the aneurysm suggestive of thrombus. Considering the high risk of systemic emboli surgery was performed, and aneurysm was repaired with Dacron patch.