Giant right atrial aneurysm with atrial fibrillation

Congenital right atrial aneurysm is a rare condition. Here we reported a 16‐year‐old male with giant right atrial aneurysm, atrial fibrillation, and atrial septal defect. Surgical resection of extensive right atrium, ASD repair, and maze procedure were performed. In the present case, we found extensive enlargement of right atrium protruding to the apex on the surface of the right ventricle. With the exist of atrial fibrillation, thrombus formation was always a lethal threat. Surgical treatment can provide excellent clinical results and further avoided life‐threatening complications.     

Left atrial appendage aneurysm with paroxysmal atrial fibrillation

Aneurysm of the left atrial appendage is extremely rare, and afflicted patients most commonly present with atrial tachyarrhythmia or thromboembolism. For these patients, resection of the aneurysm is the recommended and preferred therapy. We present the case of a 57-year-old woman who was found incidentally to have a large aneurysm of the left atrial appendage presenting as atrial fibrillation. After surgical intervention with resection of the aneurysm and a Cox maze III procedure, the patient recovered and was discharged in sinus rhythm.     

全胸腔镜下左心房后壁隔离治疗非瓣膜性心房颤动

目的 评价全胸腔镜下左心房后壁隔离法治疗非瓣膜性心房颤动(非瓣膜性房颤)的可行性和有效性.方法 2010年9月至2011年12月,应用全胸腔镜下左心房后壁隔离法治疗非瓣膜性房颤患者20例,其中男18例,女2例.年龄47 ～ 71岁,平均(61.5±5.6)岁.房颤病史2～ 25年,平均(6.2±4.0)年.术前心功能Ⅰ～Ⅱ级,左心室射血分数0.632±0.055.手术在全麻双腔气管插管下进行,胸腔镜下实施心外膜房颤射频消融术.术后应用胺碘酮和华法林3个月,术后1、3、6、12个月及每年随访患者并检查24 h动态心电图.结果 全组无死亡,无并发症,所有患者均顺利出院.平均手术(60.5±30.1) min,术后呼吸机使用(11.5±2.1)h.术后随访2.6～14.2个月,无阵发心悸、短脉、偏瘫等症状,无死亡或卒中,24 h动态心电图示患者均为窦性心律,房颤转复率100％.结论 初步经验显示全胸腔镜下左心房后壁隔离法治疗非瓣膜性房颤安全、有效.     

Epicardial atrial defibrillation: successful treatment of postoperative atrial fibrillation

BACKGROUND: Atrial fibrillation is the most common complication after cardiac surgery. Current medical treatment using antiarrhythmics and anticoagulants has a significant morbidity. The goal of this study was to determine if epicardial atrial defibrillation can be safely performed and return patients to sinus rhythm. METHODS: A prospective analysis of patients undergoing cardiac surgery was performed. Patients with a prior pacemaker/defibrillator, history of arrhythmia, preoperative antiarrhythmic, age greater than 85 years, history of stroke, or intraaortic balloon pump were excluded. Temporary epicardial atrial cardioversion wires were placed on the right and left atrium. Bipolar atrial and ventricular pacing wires were also placed. The wires were tested in the operating room. Patients who went into postoperative arial fibrillation were cardioverted with 3 J, 6 J, or 9 J. RESULTS: There were 45 patients enrolled. Sixteen patients (35%) went into postoperative arial fibrillation during their hospital stay. Mean time to onset of arial fibrillation was 2.6 +/- 1.4 days after surgery. Fifteen patients were successfully cardioverted to sinus rhythm on the primary cardioversion, with mean of 5.7 +/- 2.4 J. One patient was cardioverted at 6 hours after onset of arial fibrillation, at 6 J. Recurrent arial fibrillation occurred in 4 patients during their hospital stay. All 4 of these patients were cardioverted with a mean of 6.4 +/- 2.6 J. All wires were removed the day before patients were discharged. There were no complications with wire insertion or removal. There were no adverse neurologic events. The mean hospital stay was 5.1 +/- 2.2 days. All patients were in sinus rhythm at 1 month follow-up. CONCLUSIONS: The use of a temporary atrial defibrillator to resynchronize patients in postoperative arial fibrillation is safe and effective.     

The relationship between atrial pressure, atrial dimensions and atrial natriuretic factor during pacing tachycardia in dogs

Acute supraventricular tachycardia is known to increase the plasma level of atrial natriuretic factor (ANF). The purpose of these experiments was to investigate if such an increase in plasma-ANF could be ascribed to changes in atrial pressure and atrial dimensions. Eight anaesthetized dogs were instrumented with atrial pressure catheters and sonomicrometers to measure left and right auricular and atrial free wall dimensions. An acute increase in atrial rate from 150 to 200 min-1 for 10 min did not change plasma-ANF or atrial haemodynamic variables. A further increase in atrial rate to 250 or 300 min-1 increased right and left atrial intracavitary pressures (P less than 0.01), both auricular diameters and right atrial free wall segment length (P less than 0.05). Left atrial free wall segment length remained unchanged. Plasma-ANF increased in all dogs (P less than 0.01). The change in plasma-ANF correlated well with changes in atrial pressures as well as with changes in atrial dimensions. These results support the hypothesis that release of ANF during acute atrial tachycardia may in part be attributed to atrial dilatation.     

Spontaneous intramural left atrial haematoma masquerading as left atrial thrombus

Spontaneous left atrial intramural haematoma is rare. We got one such case which gave rise to cardiac tamponade. This presentation is to increase awareness about its evaluation and management.     

Epicardial atrial pacing

A modification of the technique for placing a permanent epicardial electrode to the atrium is described. It results in long-term atrial pacing and low sensing thresholds. The method requires meticulous surgical technique but is reliable, safe, and free from serious or long-term complications.     

Left atrial myxoma

8 patients with atrial myxoma were reviewed. They ranged from 5 years to 55 years. Recently echocardiography has been the most helpful diagnostic procedure. Hemodynamically they simulated mitral valve disease with severe pulmonary hypertension. Tumour was demonstrated by angiocardiography. One of these tumours presented into the right atrium through an associated atrial septal defect. All of them underwent open heart surgery and removal of the tumour. One died as a result of septicemia. Others have had excellent hemodynamic improvement.     

Self-retaining atrial retractor

A new self-retaining atrial retractor is described. It has simplified surgery on the mitral valve and other procedures done through right or left atrium.     

Right atrial hemangioma

A case of right atrial hemangioma as a rare tumor of the heart is reported. Because of its single, pedunculated mass, surgical excision of the tumor resulted in the complete treatment. Histologically, it was classified as arteriolar type. The importance of recent non-invasive techniques to diagnose these tumors during life is emphasized.     

Aorta-right atrial tunnel

Aorta-right atrial tunnel is rare. We report a case of aorta-right atrial tunnel in which the right coronary artery arose from the tunnel. Successful surgical treatment was performed.     

Left atrial aneurysm

Aneurysms of the left atrium are rare abnormalities. They can be congenital or acquired. Whereas a true congenital aneurysm presents as isolated pathology, inflammatory or degenerative processes involving the endocardium are associated with the acquired type. The clinical records of 2 patients with the diagnosis of left atrial aneurysm were reviewed, along with the surgical strategies, current literature, and patient outcomes. Because of the risk of life-threatening complications, surgery is recommended even in asymptomatic cases. Resection and mitral valvuloplasty should be the treatment of choice.