Left atrial appendage aneurysm in pediatrics

Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with potentially life-threatening complications of atrial tachyarrhythmias and systemic thromboembolism. It is often diagnosed incidentally and rarely during childhood. Echocardiography is considered the primary method of LAAA diagnosis; in particular, the subxiphoid view is more useful in pediatrics. Surgical intervention and drug management are recommended to prevent potentially lethal complications. Herein, we report five cases of patients with LAAA during infancy and childhood, caused by both congenital and acquired conditions. One patient underwent surgical resection through left lateral thoracotomy without cardiopulmonary bypass and another patient underwent drug management.     

Left atrial appendage can still cause clinical events after ligation

We present a 71-year-old female patient with transient ischaemicattack. A thrombus located at the stump of previously ligatedleft atrial appendage was suspected as the cause of event.     

Right atrial appendage aneurysm complicated with atrial septal defect: A rare case report

Right atrial appendage aneurysms (RAAAs) are rare heart malformations, presenting as isolated anomalies or co-existing with other structural heart diseases. We describe a rare case of RAAA complicated with an atrial septal defect (ASD). The diagnosis was established using transthoracic echocardiography and confirmed using cardiac magnetic resonance imaging. To treat the ASD and reduced right atrium volume load, ASD transcatheter closure was performed. On echocardiography performed 3 months post discharge, the RAAA was observed to have reduced in size compared to that presurgery. Six years later, she was in good condition without any adverse events.     

室上速并发心房颤动的电生理研究

目的探讨室上速并发心房颤动(房颤)的电生理特性及其发生机制。方法对38例室上速患者,根据有无房颤史分为两组,即房颤组18例,无房颤组20例。分别测量两组室上速周长、心房内压、心房各部位有效不应期、心房不应期离散度、心房最大不应期与室上速周长的比值,所有对象均行射频消融术治疗室上速,并行为期半年的随访,观察两组病人房颤的发生情况。结果房颤组与无房颤组的室上速周长分别为（326±9）ms,（331±11）ms,P>0.05。在窦性心律与室上速发作时,房颤组的心房不应期离散度均较无房颤组增加,房颤组的心房最大不应期与室上速周长的比值比无房颤组明显增加（P<0.05）。房颤组的心房最大不应期比无房颤组增加（P<0.05）,但却发生在心房的不同部位。结论(1)室上速合并房颤与室上速周长无明显关系。(2)心房不应期离散度是室上速合并房颤发生和维持的一个重要机制。(3)心房最大不应期与室上速周长的比值可能是室上速诱发房颤的另一个机制。     

小儿室上性心动过速的食管心电生理分型及演变

目的 :探讨小儿室上性心动过速 (SVT)的类型及其电生理特征 ,以及食管起搏对小儿SVT的干预作用。方法 :对 4 7例 8个月～ 15岁有SVT发作史的患儿进行了食管心电生理研究。结果 :4 7例SVT经食管心房调搏 (TEAP)确定分型 4 2例 (89.4 % ) ,其中旁路折返 2 8例 (6 6 .7% ) ,房室结内折返 10例 (2 3.8% ) ,心房内折返l例 ,窦房结折返l例 ,心房自律性增高 2例 ;不能定型 5例 (10 .6 % )。结论 :小儿SVT近 95 %为折返机制所致 ,以旁路折返最常见 ,其次为房室结内折返 ,与成人报道不同 ,可能与小儿传导系统发育规律以及旁路电生理特性发生演变有关     

Congenital aneurysm of the left atrial appendage

Congenital aneurysm of the left atrial appendage is quite infrequent.Most instances are asymptomatic. Patients can report a varietyof symptoms, one of the most frequent being onset of auriculartachyarrhythmia. Various imaging techniques are useful in diagnosisand allow the differential diagnosis with other pathologies. We describe the case of a 24-year-old male with congenital aneurysmof the left atrial appendage. The patient presented with auricularfibrillation. Diagnosis was based on transthoracic and trans-esophagealechocardiography, and the patient was treated by surgical resectionof the aneurysm under extracorporeal circulation.     

室上性心动过速中旁道折返的少见现象

报告阵发性室上性心动过速（PSVT）电生理检查中发现的几种少见的旁道电生理特性。例1为一左侧隐匿性房室旁道参与的房室折返性心动过速,其心室扫描示旁道逆向有效不应期260ms,但520－390ms时无逆向传导功能。例2为一慢－慢型房室交接区折返性心动过速,同时存在一条右侧隐匿性房室旁道作为旁观者。例3为一宽QRS波群心动过速,其体表心电图呈典型马海姆纤维型预激综合征,电生理揭示存在左侧房室隐匿性旁道和束室旁道两条附加旁道,前者为心动过速的逆传支,后者与房室结－希室束同为顺传支。对上述几种少见的电生理现象临床意义进行讨论。     

Right atrial appendage tachycardia: A rare cause of tachycardia induced cardiomyopathy with successful radiofrequency ablation using the 3D mapping system

We report the case of a 40-year-old patient with incessant supraventricular tachycardia (SVT). As this SVT was resistant to medical therapy and was complicated by severe LV dysfunction and cardiogenic shock, the patient was referred for EPS (electrophysiologic study) and ablation. EPS and successful ablation of the right atrial appendage (RAA) tachycardia were performed by means of a 3D mapping system NavX (St. Jude Medical, St. Paul, MN, USA) with complete resolution of symptoms and normalization of LV function, as evaluated at three-month follow-up examination.     

Huge left atrial appendage aneurysm revealed by chronic hiccups

Left atrial appendage (LAA) aneurysm is an extremely rare anomaly. So far, less than one hundred cases only have been reported worldwide. Revelation modes are dominated by complications such as arrhythmias and thromboembolic events. We herein report a pediatric case of huge congenital LAA aneurysm with an original revelation mode that has never been described before in medical literature.     

Ethanol infusion in left atrial appendage vein for treating refractory left atrial appendage tachycardia

Introduction

We describe an unusual case of atrial tachycardia (AT) emanating from the left atrial appendage body (LAA), successfully treated by chemical ablation.

Methods

A 66-year-old patient with cardiac amyloidosis and history of persistent atrial fibrillation ablation presented poorly tolerated AT with 1:1 atrioventricular nodal conduction at 135/min, despite amiodarone therapy. Three-dimensional mapping suggested a reentrant AT from the anterior aspect of the left LAA.

Results

The tachycardia could not be terminated with radiofrequency ablation. The LAA vein was then selectively catheterized and infused with Ethanol, resulting in immediate termination of tachycardia, without LAA isolation. No recurrence occurred at 12 months.

Conclusion

Atrial tachycardias emanating from the LAA that are resistant to radiofrequency ablation may respond to chemical ablation of the LAA vein.     

A rare giant congenital left atrial appendage aneurysm in a 1‐day‐old newborn

Congenital left atrial appendage aneurysm (LAAA) is a very rare condition and occurs as a result of congenital dysplasia of musculi pectinate. These patients may be asymptomatic and/or may present with dyspnea, and thromboembolic events. The most common complications are life‐threatening thromboembolic events and supraventricular tachyarrhythmias. Transthoracic echocardiography plays a very important role in the diagnosis of LAAA. Herein, we present a rare case of giant congenital LAAA.     

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.     

Left atrial appendage thrombus outside of a 'successful' ligation.

A 79-year-old woman with severe aortic stenosis underwent aortic valve replacement surgery, and had ligation of the left atrial appendage (LAA) using an epicardial approach. On a post-operative echocardiographic evaluation, the distal portion of the LAA was excluded, leaving no communication with the left atrium. The proximal portion of the LAA, however, was in continuity with the circulation and a large thrombus was present within it. While previous reports of incomplete LAA ligation have involved disruption of the suture line, this present report describes a case of incomplete ligation due to persistence of the proximal portion of the appendage. Thus, thrombus formation occurred despite a 'successful' epicardial exclusion of the distal LAA.     

左心耳来源的局灶性房性心动过速的临床特点和治疗杨秀婷金元超 曾艳 张雨薇刘启功

左心耳来源的房性心动过速非常少见,多呈持续性发作,药物疗效不佳,容易导致心动过速性心肌病。心电图表现为：Ⅰ和aVL导联P波倒置,Ⅱ、Ⅲ、aVF导联P波直立。左心耳来源的房性心动过速多为自律性增高或微折返机制,电生理检查可明确发生机制及房速的起源部位。导管消融风险较大,也可直接外科手术切除左心耳。