The dangerous fifth chamber: congenital left atrial appendage aneurysm

Aneurysms of the left atrial appendage are extremely rare. Enlargement of the left atrial appendage can be congenital or acquired. Dysplasia of the left atrial muscles leads to congenital left atrial appendage aneurysm and usually presents as atrial tachyarrhythmia or embolic events in the second or third decade of life. We report a case of an asymptomatic 12-year-old child with a congenital left atrial appendage aneurysm. Transthoracic and transoesophageal echocardiography demonstrated a large left atrial appendage aneurysm without thrombus or spontaneous echo-contrast. The patient was successfully treated with surgical resection of the aneurysm.     

Congenital aneurysm of the left atrial appendage

Congenital aneurysm of the left atrial appendage is a rare anomaly, usually presenting in adult life. We report the case of a 31-year-old woman with a marked prominence of the upper left heart border at the chest X-ray in whom the diagnosis of congenital aneurysm of the left atrial appendage was confirmed by cross-sectional echocardiography and computed tomography. Up to few years ago angiography was considered the method of choice in establishing the diagnosis. Cross-sectional echocardiography has recently become a safe and reliable method for diagnosing congenital aneurysm of the left atrium and should be considered in any case with abnormality of the profile of left atrium on the chest radiography.     

先天性左房瘤1例报告及文献复习

先天性左房瘤是一种罕见的心脏畸形。至今国外文献仅报告４０余例，国内仅７例。我们报告１例５岁女孩术前无症状，胸片发现左心缘扩大，超声心动图明确诊断。在体外循环下行瘤体切除，治愈出院。结合文献对本病临床特点、诊断、治疗及预后进行讨论。     

Resolution of Thrombi in Left Atrial Appendage Aneurysm

Atrial appendage aneurysm is a rare cardiac disease and may be complicated by embolic events and rhythm disturbances. We describe a case of a congenital left atrial aneurysm presenting with a cere-brovascular accident in a 57-year-old female. The diagnosis was made by transesophageal echocardiography, which revealed the presence of intraaneurysmal thrombi. The patient initially received anticoagulant therapy and the thrombi were resolved. Subsequently, she was successfully operated on and the aneurysm was removed. This is the first report of thrombi resolution in a left atrial appendage aneurysm.     

Left atrial appendage aneurysm: a rare cause of paroxysmal supraventricular tachycardia

Left atrial appendage aneurysm is a rare abnormality and a diagnostic dilemma in patients with cardiomegaly. Patients most commonly present with atrial tachyarrhythmias and thromboembolic events. Resection of the aneurysm is usually curative. We report herein the case of a 27-year-old man with massive left atrial appendage aneurysm diagnosed incidentally in the course of pre-operative evaluation for a non-cardiac surgery. The marked cardiomegaly detected in a routinely ordered pre-operative chest X-ray and the history of previous episodes of palpitation accompanied by chest discomfort guided us to the diagnosis. The diagnosis was made by transthoracic echocardiography and confirmed by angiography and then surgery.     

Left atrial appendage aneurysm: correlation of noninvasive with clinical and surgical findings: report of a case.

Congenital left atrial appendage aneurysm is rarely diagnosed on the basis of an abnormal cardiac silhouette. Patients with a left atrial appendage aneurysm often present with symptoms of systemic emboli or supraventricular arrhythmias. A patient with left atrial appendage aneurysm was diagnosed by correlation of two noninvasive techniques echocardiography and radionuclide scintiscanning. Angiography was confirmatory and aneurysmectomy was successfully performed.     

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.     

Left atrial appendage aneurysm: echocardiographic diagnostic

The left atrial appendage aneurysm is a rare condition that frequently manifests itself by heart arrhythmias or thromboembolism. We report the case of a patient with left atrial appendage aneurysm, diagnosed by echocardiography and submitted to surgical resection.     

Regional left atrial stasis during fibrillation and flutter determinants and relation to stroke

Objectives. This study sought to 1) determine the location of left atrial stasis during atrial arrhythmia; 2) define the degree of stasis associated with significant risk of stroke; and 3) identify clinical or transthoracic echocardiographic data useful for predicting left atrial stasis.

Background. Prior studies suggest that stroke during atrial arrhythmia is related to stasis in either the body of the left atrium or the appendage. Recent data indicate that appendage stasis is associated with appendage thrombus formation, but stroke during atrial arrhythmia occurs frequently in the absence of appendage stasis.

Methods. Blood flow velocity was measured in multiple sites in the body of the left atrium and in the appendage by transesophageal pulsed wave Doppler echocardiography in 89 patients with atrial fibrillation or flutter. Regional velocities were related to the frequency of probable embolic stroke and to clinical and transthoracic echocardiographic variables.

Results. The lowest velocity region was either the posterior left strium or the appendage. Stroke frequency increases progressively and steeply with velocity <15 cm/s is either region; this cutoff value had an 87% sensitivity and 40% specificity for stroke. Factors related to stasis were low left atrial ejection fraction, mitral regurgitation <3+, fibrillation (vs. type 1 flutter), left ventricular dilation and mitral valve area <2.0 cm².

Conclusions. Posterior left atrial stasis appears to the as important as appendage statis for the risk of stroke, which increases sleeply with lower blood flow velocity in either region. Patients likely to have severe stasis during atrial arrhythmia are those with left ventricular dilation and low atrial ejection fraction accompanying left atrial dilation. Direct measurement of atrial velocity by transesophageal echocardiography appears to be useful for the identification of patients at risk for stroke during atrial arrhythmia.     

Congenital aneurysm of left atrial appendage.

Congenital aneurysm of the left atrial appendage is a rare anomaly, usually presenting in adult life. The case reported is that of a 55-year-old man who died of cerebral embolism originating from a thrombus in a congenital aneurysm of the left atrial appendage. The cardiac silhouette 11 years previously had suggested a cardiac tumour or a pericardial cyst. As judged frm 14 published cases, the major manifestations of these aneurysms are an abnormal cardiac silhouette in the x-ray, supraventricular tachycardia, and systemic embolism. Angiocardiography appears to be the method of choice in establishing the diagnosis. Resection of th aneurysm is the recommended form of treatment.     

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.     

Intrapericardial left atrial appendage aneurysm

An intrapericardial left atrial appendage aneurysm is described in a 36 year old female. She was asymptomatic except for intermittent palpitations. The aneurysm was initially diagnosed by 2D-echocardiogram and confirmed by pulmonary cineangiogram. In addition to compression and indentation of the anterolateral wall of the left ventricle, hypokinesis was noted, which we believe has not been reported previously, in association with the left atrial appendage aneurysm, and which improved after surgical resection. The patient is symptom-free at a 5 year follow-up. A review of the literature is presented.     

Intrapericardial giant left atrial appendage

Contrary to what the name implies, the left atrial appendage is increasingly becoming an organ of clinical importance. Its role in the pathogenesis of thromboembolism is now well established. Enlargement of the appendage due to haemodynamic disturbances or anatomic weakness increases this risk, along with the potential for arrhythmia. We report a rare case of gross enlargement of the left atrial appendage within the pericardial cavity.     

An Unusual Cardiac Defect in a Patient with Clinical Features Overlapping Between Cardiofaciocutaneous and Noonan Syndromes

It is important to recognize the possibility of a syndromic etiology of cardiac defects when dysmorphic features and other congenital defects are present. We report a patient who presented with atrial fibrillation and was found to have an abnormal mitral valve, congenital aneurysm of the left atrial appendage, and features consistent with both Cardiofaciocutaneous syndrome and Noonan syndrome. The congenital aneurysm of the left atrial appendage was a previously unreported cardiac presentation for either syndrome. Diagnostic considerations based upon his genotype and phenotype are discussed, along with his unique cardiac presentation and treatment.     

Congenital giant aneurysm of the left atrial appendage mimicking pericardial absence case report

A 25-year-old man was found to have an abnormal cardiac contour on a chest radiograph, and was referred. Transesophageal echocardiography suggested herniation of the left atrial appendage (LAA) through a gap in the pericardium, and magnetic resonance imaging indicated congenital partial absence of the pericardium. Cardiac dysfunction was caused by compression from the enlarged left atrium and thrombi were thought to be present in the appendage, so surgery was performed. The intraoperative diagnosis was congenital LAA aneurysm. Although distinguishing between congenital LAA aneurysm and congenital absence of the pericardium is reported to be possible with magnetic resonance imaging, we were unable to so in this case.     

Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature

We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient''s atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy.Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.     

Evidence-based percutaneous closure of the left atrial appendage in patients with atrial fibrillation

Atrial fibrillation is the most common cardiac arrhythmia, and its prevalence is increasing. Cardioembolic stroke, most of the times secondary to thrombus formation in the left atrial appendage, is its most feared and life threatening consequence. Oral anticoagulation with vitamin-K-antagonists is currently the most used prophylaxis for stroke in patients with atrial fibrillation; unfortunately, its benefits are limited by a narrow therapeutic window and an increased risk for bleeding, making it often undesired. Percutaneous occlusion of the left atrial appendage is a novel alternative strategy for cardioembolic stroke prophylaxis in patients with atrial fibrillation at a high risk of stroke but with contraindication for long-term oral anticoagulation therapy. At present, several devices have been developed specifically for percutaneous occlusion of the left atrial appendage. Current results show good feasibility and efficacy for these devices, with a high rate of successful implantation, although also associated with the inherent potential periprocedural complications. This work reviews the current state of the art of percutaneous left atrial appendage closure for stroke prophylaxis in patients with atrial fibrillation.     

Myocardial magnesium: relation to laboratory and clinical variables in patients undergoing cardiac surgery

Magnesium concentration was measured in the right atrial appendage of 100 patients undergoing cardiac surgery and associations with serum and mononuclear blood cell magnesium, other laboratory values and patient clinical variables were studied. In addition, magnesium was measured in the right atrial appendage and left ventricular free wall in 23 autopsy subjects to determine whether there was a proportional relation between right atrial appendage and left ventricular free wall magnesium. The mean left ventricular free wall/right atrial appendage magnesium ratio was 2.13 +/- 0.39 (r = 0.67, p = 0.0009). In the group with cardiac surgery, the right atrial appendage magnesium concentration correlated inversely with age (r = -0.54, p = 0.001). The mean right atrial appendage magnesium concentration (micrograms/g wet weight tissue) was lower in patients with postoperative cardiac arrhythmia than in those without arrhythmia (103 +/- 13 versus 111 +/- 10, p = 0.009) and in diabetic than in nondiabetic patients (103 +/- 13 versus 109 +/- 12, p = 0.02). The right atrial appendage magnesium concentration also tended to be lower in patients receiving potassium/magnesium-losing diuretics, although this difference did not achieve statistical significance (105 +/- 14 versus 109 +/- 11, p = 0.16). Right atrial appendage magnesium concentration correlated positively with serum creatinine concentration (r = 0.31, p = 0.002) and negatively with serum calcium concentration (r = -0.29, p = 0.013). Serum magnesium did not correlate with right atrial appendage or mononuclear blood cell magnesium concentration or clinical variables. There was a statistically significant correlation between mononuclear blood cell and right atrial appendage magnesium concentrations in some subgroups of patients.     

Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation

Atrial fibrillation (AF) is a commonly sustained atrial arrhythmia with associated morbidity and mortality. AF is associated with increased risk of thromboembolism and stroke, requiring use of anticoagulation. Anticoagulation decreases the risk of stroke but is associated with a higher risk of bleeding, necessitating discontinuation in some patients. The left atrial appendage is the likely source of thrombus in the majority of patients with AF. This has led to the development of left atrial appendage occlusion as a means to reduce stroke risk in patients who have a contraindication to long‐term anticoagulation. Multiple implantable devices have surfaced in the last few years, with some promising prospects. The main purpose of this review is to highlight the indications and use of these devices for left atrial appendage occlusion.     

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 usually be performed. Once the diagnosis is confirmed, surgery is indicated even in the asymptomatic patient because of the risk of systemic embolism.