|
1
|
Daralammouri Y, Odeh A, Abuzahra S, Azamtta M, Shawahna R. Left atrial appendage aneurysm: a descriptive systematic review of 177 cases. BMC Cardiovasc Disord 2024; 24:633. [PMID: 39528946 PMCID: PMC11552148 DOI: 10.1186/s12872-024-04323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Yunis Daralammouri
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- Cardiology Department, An-Najah National University Hospital, Nablus, Palestine.
| | - Anas Odeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Saad Abuzahra
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Murad Azamtta
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Cardiology Department, An-Najah National University Hospital, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine
| |
Collapse
|
|
2
|
Vaideeswar P, Zare P, Bhatia P. Unusual cardiac aneurysms: a surgical pathology experience. Cardiovasc Pathol 2024; 72:107662. [PMID: 38815840 DOI: 10.1016/j.carpath.2024.107662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024] Open
Abstract
Among the cardiac outpouchings, left ventricular aneurysms or pseudo-aneurysms that develop secondary to myocardial infarctions are the most common. On the other hand, atrial appendageal and valvular aneurysms are uncommon occurrences. The appendageal aneurysms develop possibly due to congenital dysplasia of atrial pectinate muscles, while valvular aneurysms result from infective endocarditis, mechanical injury or degenerative changes. Despite their unusual locations, they are prone to life-threatening complications. We present our experience of unusual cardiac aneurysms in surgical cardiovascular material.
Collapse
Affiliation(s)
- Pradeep Vaideeswar
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India.
| | - Pranita Zare
- Department of Pathology (Cardiovascular & Thoracic Division), Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Pranav Bhatia
- Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
|
3
|
Mittal A, Navaratnarajah M, Harden S, Velissaris T, Roberts PR. Staged hybrid ablation in left atrial appendage aneurysm a rare cause of refractory atrial tachyarrhythmia-a case report. Eur Heart J Case Rep 2024; 8:ytae298. [PMID: 38962158 PMCID: PMC11217816 DOI: 10.1093/ehjcr/ytae298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/07/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
Background Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly, which can be congenital or acquired in origin. Because most cases are asymptomatic, it is typically diagnosed incidentally in the second to third decades of life. We present a case of a 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance. The informed consent was given by patient for this manuscript. Case summary We present a case of a 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance after an episode of COVID respiratory infection. He was referred by primary care physician for management of atrial fibrillation (AF) with CHA2DS2Vasc score zero. He had documented AF and atrial flutter (AFL) resistant to both chemical and electrical cardioversions. Initial portable focused transthoracic echocardiography documented borderline reduced left ventricular ejection fraction in context of AFL. Electrophysiological study confirmed the diagnosis of typical AFL. Successful radiofrequency ablation of cavo-tricuspid isthmus resulted in bidirectional isthmus conduction block. However, patient developed AF, which was electrically cardioverted at the end of procedure. Patient was discharged on bisoprolol, ramipril, and apixaban, and outpatient cardiac MRI was organized to look for post-COVID myocardial scarring. Patient had recurrence of symptoms, and this time it was due to AF. Multimodal imaging led to discovery of LAAA, in which after discussion in multidisciplinary meeting, he was accepted for and managed with surgical resection of LAAA with concomitant Cox-Maze IV procedure. On 9 months post-operative follow up, patient is maintaining sinus rhythm and has completely returned to baseline activities. Discussion A young patient with refractory atrial arrhythmia should be referred for multimodal cardiovascular imaging to rule out any structural heart disease. Left atrial appendage aneurysm is rare and can be managed conservatively, but surgical excision is most reported and appears to favour arrhythmia-free survival.
Collapse
Affiliation(s)
- Ashish Mittal
- Dept. of Cardiac Electrophysiology, St Bartholomew’s Hospital Heart Centre, London EC1A 7BE, UK
| | - Manoraj Navaratnarajah
- Dept. of Cardiothoracic Surgery, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Stephen Harden
- Dept. of Cardiothoracic Radiology, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Theodore Velissaris
- Dept. of Cardiothoracic Surgery, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Paul R Roberts
- Dept. of Cardiovascular Medicine, University Hospital Southampton, Southampton SO16 6YD, UK
| |
Collapse
|
|
4
|
Abuzahra S, Odeh A, Khdour I, Nairat M, Azamtta M, Saifi M, Younis O, Daralammouri Y. Imaging reveals a fifth heart chamber: Diagnosing and treating a massive left atrial appendage aneurysm. Radiol Case Rep 2024; 19:1136-1140. [PMID: 38259714 PMCID: PMC10801141 DOI: 10.1016/j.radcr.2023.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/18/2023] [Accepted: 11/21/2023] [Indexed: 01/24/2024] Open
Abstract
In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.
Collapse
Affiliation(s)
- Saad Abuzahra
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Anas Odeh
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Issa Khdour
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiothoracic Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Muath Nairat
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiothoracic Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Murad Azamtta
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Motaz Saifi
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Omar Younis
- School of Medicine, Faculty of Medicine and Health Sciences, An Najah National University, Nablus, Palestine
| | - Yunis Daralammouri
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Cardiology, An-Najah National University Hospital, Nablus, 44839, Palestine
| |
Collapse
|
|
5
|
Ayala Torres JD, Sepulveda Gallego JA, Gonzalez Gonzalez M. Left Atrial Appendage Aneurysm: A Case Report and Literature Review. Cureus 2024; 16:e56280. [PMID: 38623095 PMCID: PMC11018009 DOI: 10.7759/cureus.56280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/17/2024] Open
Abstract
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.
Collapse
|
|
6
|
Fadel R, Khan E, Maskoun W. Deployment of left atrial appendage occlusion device in large aneurysmal left atrial appendage: a case report. Eur Heart J Case Rep 2024; 8:ytae117. [PMID: 38496797 PMCID: PMC10941255 DOI: 10.1093/ehjcr/ytae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/16/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Affiliation(s)
- Raef Fadel
- Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA
| | - Essaq Khan
- Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA
| | - Waddah Maskoun
- Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202, USA
| |
Collapse
|
|
7
|
Chan YJ, Ly Ly NT, Hai NM, Jan SL. Case Report: One heart with two lobes: a rare infantile congenital giant left atrial appendage aneurysm. Front Pediatr 2023; 11:1302182. [PMID: 38054189 PMCID: PMC10694266 DOI: 10.3389/fped.2023.1302182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/02/2023] [Indexed: 12/07/2023] Open
Abstract
Left atrial appendage aneurysm (LAAA) is an extremely rare congenital heart abnormality, with varying degrees of symptoms, ranging from asymptomatic to arrhythmia, thromboembolic event or airway obstruction. Most infantile cases were incidentally found by echocardiography. Contrast-enhanced chest tomography can confirm the diagnosis and inform surgical plan. We describe an asymptomatic young female infant who had a unique extreme cardiomegaly on a chest x-ray and received surgical aneurysmectomy. Her heart was restored to a normal cardiac size after the heart surgery.
Collapse
Affiliation(s)
- Yu-Jen Chan
- Department of Pediatrics, Da Chien Hospital, Miaoli, Taiwan
| | - Nguyen Thi Ly Ly
- Division of PediatricCardiology, Dong Nai Children’s Hospital, Bien Hoa, Vietnam
| | - Nguyen Minh Hai
- Division of Pediatric Cardiology, Nhi Dong No1 Hospital, Ho Chi Minh, Vietnam
| | - Sheng-Ling Jan
- Division of Pediatric Cardiology, Children’s Medical Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Pediatrics, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
|
8
|
Aksu T, Mutluer FO, Cabbar AT, Huang HD. A giant left atrial appendage aneurysm with left atrial flutter: feasibility of catheter ablation strategy. J Interv Card Electrophysiol 2023; 66:1765-1768. [PMID: 37599320 DOI: 10.1007/s10840-023-01622-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey.
| | - Ferit Onur Mutluer
- Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey
| | - Ayca Turer Cabbar
- Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey
| | - Henry D Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| |
Collapse
|
|
9
|
Norozi K, Subasri M, Diaz LA, Honjo O. Left atrial appendage aneurysm in pediatrics: Case study and literature review. Front Cardiovasc Med 2023; 10:1211619. [PMID: 37636313 PMCID: PMC10449248 DOI: 10.3389/fcvm.2023.1211619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Kambiz Norozi
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
- Department of Paediatric Cardiology, Medical School Hannover, Hannover, Germany
| | - Mathushan Subasri
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Luis Altamirano Diaz
- Department of Paediatrics, University of Western Ontario, London, ON, Canada
- Division of Pediatric Cardiology, Department of Paediatrics, London Health Sciences Centre, London, ON, Canada
- Pediatric Cardiopulmonary Research Laboratory, London Health Sciences Centre, London, ON, Canada
- Children Health Research Institute, London, ON, Canada
| | - Osami Honjo
- Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
|
10
|
Xiong J, Wenbo Y, Gao J, Li M, Yu D. Radiofrequency ablation-induced superior vena cava stenosis in a 5-year-old boy with congenital left atrial appendage deformity: a case report and literature review. Front Surg 2023; 10:1199335. [PMID: 37492621 PMCID: PMC10365907 DOI: 10.3389/fsurg.2023.1199335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
Superior vena cava (SVC) stenosis is rarely caused by iatrogenic trauma. Herein, the case of a 5-year-old boy who underwent radiofrequency ablation for paroxysmal supraventricular tachycardia but developed SVC stenosis and related syndromes is reported. Notably, the child exhibited an enlarged left atrial appendage that had partially breached the pericardium. Subsequent interventions involved successful removal of the stenosis, artificial vascular reconstruction, and comprehensive radiofrequency ablation of the entire right atrium, along with ligation of the left atrial appendage under direct vision. As a result, the child experienced relief from symptoms.
Collapse
Affiliation(s)
- Jianxian Xiong
- Department of Cardiovascular Surgery, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yu Wenbo
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Jianfeng Gao
- The First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Meifang Li
- Department of Breast Disease Comprehensive Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Dongmin Yu
- Department of Breast Disease Comprehensive Center, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| |
Collapse
|
|
11
|
Penfold MP, Haq IU, Connolly HM, Dearani JA, Schaff HV, Miranda WR, Asirvatham SJ, Killu AM, Arghami A, Stephens EH. Atrial Appendage Aneurysms: Natural History and Outcomes. World J Pediatr Congenit Heart Surg 2023; 14:474-480. [PMID: 36972504 DOI: 10.1177/21501351231162909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Left (LAAA) and right atrial appendage aneurysms (RAAA) are rare entities, and their natural history, management, and long-term outcomes are not well studied. METHODS This retrospective review includes all patients from 2000 to 2021 with atrial appendage aneurysms at our institution identified using an electronic search tool. LAAA and RAAA were confirmed using multimodality imaging and intraoperative findings. RESULTS We identified 13 (87%) patients with LAAA and 2 (13%) with RAAA. At diagnosis, 11 (73%) were female, mean age was 51.4 ± 18.8 years, and ejection fraction 56.5 ± 13.1%. Three (20%) patients had congenital heart disease including 2 (13%) with atrioventricular septal defects and 1 (7%) with congenitally corrected transposition. LAAA/RAAA was diagnosed due to new-onset atrial fibrillation (AF) in 6 (40%) patients and embolic stroke in 2 (13%). Ten patients had preexisting AF diagnosed 2.9 ± 1.4 years earlier at a mean age of 50.2 ± 15.5 years. Thrombus within the aneurysm was identified in 2 (15%) LAAA patients. All patients were on anticoagulation and follow-up of the cohort from diagnosis was 7.1 ± 6.2 years. Eleven (73%) patients were surgically managed with 7 (64%) lesions excised, 1 (9%) stapled, and 3 (27%) ligated. Postoperative complications occurred in 2 (18%) patients with 1 (7%) developing tricuspid regurgitation and another with pericardial effusion and tamponade. CONCLUSIONS Atrial appendage aneurysm is a rare disease and nearly half of patients present with AF. Surgical treatment with concomitant AF ablation is a reasonable and safe management option.
Collapse
Affiliation(s)
| | - Ikram-Ul Haq
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Samuel J Asirvatham
- Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
|
12
|
Cheng H, Sandeep B, Fang Z, Xiao Z. Giant left atrial aneurysm with normal left atrial appendage: A case report. Asian J Surg 2023:S1015-9584(23)00357-3. [PMID: 36990816 DOI: 10.1016/j.asjsur.2023.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 03/28/2023] Open
|
|
13
|
Choi YJ, Kim JS, Cha YK, Han KM. Left Atrial Appendage Aneurysm: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1400-1405. [PMID: 36545412 PMCID: PMC9748453 DOI: 10.3348/jksr.2021.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/30/2021] [Accepted: 04/19/2022] [Indexed: 06/17/2023]
Abstract
Left atrial appendage aneurysm (LAAA) is a rare heart anomaly caused by congenital dysplasia of the pectinate muscle or by an acquired pathological condition of the mitral valve or cardiac muscle. It is often incidentally discovered during chest CT or echocardiography as an abnormal dilatation of the LAA. LAAA is associated with life-threatening complications and most patients require surgical treatment. Therefore, it is important to evaluate associated complications as well as precise diagnoses. This report presents the case of a surgically confirmed LAAA in a 53-year-old female. We also discuss the pathophysiology of LAAA and significant findings related to mortality that can be detected on CT and MRI.
Collapse
|
|
14
|
Minimally invasive resection of a giant left atrial appendage aneurysm. JTCVS Tech 2022; 16:219-222. [PMID: 36510538 PMCID: PMC9737027 DOI: 10.1016/j.xjtc.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
|
|
15
|
Dong J, Ma X. Uncommon Female-Predominant Etiologies of Cryptogenic Stroke. Front Neurol 2022; 13:900991. [PMID: 35812089 PMCID: PMC9263352 DOI: 10.3389/fneur.2022.900991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
The etiologies of cryptogenic stroke are complex and heterogeneous. A number of uncommon etiologies are not fully recognized, some of which predominantly affect females. Most of these etiologies are closely related to the hormonal level, reproductive factors, coagulation function, and medications of females. Moreover, once cryptogenic stroke is diagnosed, females tend to have worse outcomes. Therefore, prompt etiological recognition and treatment are crucial for good recovery. The aim of this article is to review advances in exploring uncommon female-predominant etiologies of cryptogenic stroke. These etiologies are categorized into arterial, cardiac, and venous sources. Arterial vasoconstrictive narrowing, intimal injury, and intimal developmental abnormality can cause brain ischemia or artery-to-artery cerebral embolism. Myocardial contraction dysfunction, cardiac wall injury, and developmental abnormality can induce intracardiac thrombosis and lead to cardiac embolism. In addition, cortical venous thrombosis and occult venous thromboembolism via intracardiac or extracardiac channels also account for cryptogenic stroke in females. Due to the lack of knowledge, in clinical practice, the above etiologies are seldom assessed. The low incidence rate of these etiologies can lead to missed diagnosis. This review will provide novel clinical clues for the etiological diagnosis of cryptogenic stroke and will help to improve the management and secondary prevention of stroke in the female population. In the future, more studies are needed to explore the etiology and prevention strategies of cryptogenic stroke.
Collapse
Affiliation(s)
- Jing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Disorders, Beijing, China
- Clinical Center for Cardio-Cerebrovascular Disease of Capital Medical University, Beijing, China
- *Correspondence: Xin Ma
| |
Collapse
|
|
16
|
Li R, Ma F, Guan HX, Pan YY, Liu LG, Wang DW, Wang H. Case Report: Giant Congenital Left Atrial Appendage Aneurysm Presenting With Acute Massive Cerebral Infarction and Refractory Atrial Fibrillation: A Case Report and Literature Review. Front Cardiovasc Med 2022; 9:888825. [PMID: 35620516 PMCID: PMC9127081 DOI: 10.3389/fcvm.2022.888825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 12/10/2022] Open
Abstract
Background Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with a variety of presentations, from being asymptomatic to potentially serious complications such as systemic thromboembolism and atrial tachyarrhythmia. Case Presentation We report a case of congenital giant LAAA in a 35-year-old man presenting with acute massive cerebral infarction and atrial fibrillation (AF) with rapid ventricular rate. The AF was refractory to conventional antiarrhythmic agents, such as amiodarone and electrical cardioversion, but restored and maintained sinus rhythm after surgical resection of LAAA. The patient remained free of events and was in sinus rhythm during half-year follow-up. Conclusion Giant LAAA has the potential causing serious complications and should be managed surgically in most cases.
Collapse
Affiliation(s)
- Rui Li
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Ma
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Han Xiong Guan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Ying Pan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Gang Liu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Wang
- Division of Cardiology, Department of Internal Medicine, Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hong Wang,
| |
Collapse
|
|
17
|
Nakamura M, Takemoto K, Terada K, Fujita S, Tanimoto T, Tanaka A. Left Atrial Appendage Aneurysm Diagnosed by Transthoracic Echocardiography. Circ J 2022; 86:1147. [DOI: 10.1253/circj.cj-21-0974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masashi Nakamura
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Kosei Terada
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Suwako Fujita
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| |
Collapse
|
|
18
|
Low ZK, Yap KH, Fortier MV, Nakao M. Congenital left atrial appendage aneurysm with unexpected course of left anterior descending coronary artery. Interact Cardiovasc Thorac Surg 2021; 32:495-496. [PMID: 33221886 DOI: 10.1093/icvts/ivaa267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 05/29/2020] [Accepted: 10/13/2020] [Indexed: 11/13/2022] Open
Abstract
The left atrial appendage (LAA) aneurysm is a rare condition that can produce local compressive effects and complications including supraventricular tachyarrhythmias, thromboembolic events and myocardial ischaemia. We present a rare case of a neonate with a congenital LAA aneurysm which resulted in local compressive effects on the left ventricle, severe mitral regurgitation and malposition of the left anterior descending (LAD) coronary artery. Intraoperatively, the LAD was found to be within the aneurysmal wall exterior to the left ventricular epicardium and was inadvertently injured during LAA aneurysm resection. Retrospective review of the preoperative computed tomography and echocardiography scans demonstrated the LAD lying within the wall of the LAA aneurysm, although this had not been well appreciated at that time. This highlights the importance of thorough multimodal preoperative imaging and intraoperative assessment for recognition of this rare association between the LAA aneurysm and LAD malposition, and prevention of inadvertent LAD injury during aneurysm resection.
Collapse
Affiliation(s)
- Zhao Kai Low
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Hooi Yap
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| | - Marielle Valerie Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Masakazu Nakao
- Department of Cardiothoracic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
| |
Collapse
|
|
19
|
Belov DV, Moskalev VI, Garbuzenko DV, Arefyev NO. Left atrial appendage aneurysm: A case report. World J Clin Cases 2020; 8:4443-4449. [PMID: 33083403 PMCID: PMC7559682 DOI: 10.12998/wjcc.v8.i19.4443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/08/2020] [Accepted: 09/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An aneurysm of the left atrial appendage is one of the rare but potentially hazardous heart defects. The risk of lethal complications grows with its size. To date, about 150 cases of this defect have been described in the literature. We present a case of left atrial appendage aneurysm with the deformation of the mitral valve and the left main coronary and circumflex artery, which required mitral valve annuloplasty and bifurcation stenting. CASE SUMMARY A 58-year-old man presented to our hospital complaining of shortness of breath, general weakness, dizziness during physical exertion, and fatigue. Based on the results of echocardiography, an aneurysm of the left atrium was suspected. A free-breathing real-time cine magnetic resonance imaging with electrocardiograph synchronization confirmed the diagnosis of left atrial appendage aneurysm. The patient underwent an aneurysmectomy via a median sternotomy with cardiopulmonary bypass. Intraoperative transesophageal echocardiography revealed relative mitral insufficiency that was corrected with an annuloplasty ring. Intraoperative coronary angiogram showed impaired blood flow in the left main coronary and circumflex artery and 60% stenosis. For this reason, bifurcation stenting was performed. The patient had an uneventful postoperative clinical course and was discharged from the hospital on the 10th day in a satisfactory condition. CONCLUSION Left atrial appendage aneurysm is a rare and dangerous heart pathology that requires surgery to prevent related complications.
Collapse
Affiliation(s)
- Dmitry Vladimirovich Belov
- Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia
- Department of Hospital Surgery, Federal Center for Cardiovascular Surgery, Chelyabinsk 454033, Russia
| | | | | | - Nikolay Olegovich Arefyev
- Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk 454092, Russia
| |
Collapse
|
|
20
|
Zhang X, Li P, Cao Y, Li X, Duan X, Bai S, Wang F. Left atrial appendage aneurysm in pediatrics. Echocardiography 2020; 37:917-921. [DOI: 10.1111/echo.14677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/25/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022] Open
Affiliation(s)
- Xin Zhang
- Heart Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Pei Li
- Heart Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Yongli Cao
- Imaging Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Xiaofeng Li
- Heart Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Xiaomin Duan
- Imaging Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Song Bai
- Heart Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| | - Fangyun Wang
- Heart Center Beijing Children's HospitalCapital Medical UniversityNational Center for Children’s Health Beijing China
| |
Collapse
|
|
21
|
Fakhri G, Obeid M, El Rassi I, Tabbakh A, Bitar F, Alameddine M, Arabi M. Large congenital left atrial wall aneurysm: An updated and comprehensive review of the literature. Echocardiography 2020; 37:965-970. [PMID: 32428351 DOI: 10.1111/echo.14687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/29/2020] [Accepted: 04/21/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Congenital left atrial wall aneurysms are rare abnormalities that arise from a developmental weakness in the muscular wall. It may be misdiagnosed or go undetected and the delay in diagnosis can lead to catastrophic consequences. CASE PRESENTATION An updated and comprehensive review of the literature was performed for all patients with this abnormality under the age of 18. A total of 15 cases including ours are presented in this article. We present a 10-month-old boy who was referred to our center for cardiomegaly. Workup revealed a large atrial wall aneurysm that was successfully corrected with surgery. CONCLUSION Historically, left atrial aneurysms were uncommon in the absence of valvular heart disease or other cardiac conditions. Congenital aneurysms are rare phenomenon because they arise without an acquired cardiac disease and surgical correction is crucial for survival.
Collapse
Affiliation(s)
- Ghina Fakhri
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mounir Obeid
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Issam El Rassi
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Anas Tabbakh
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mona Alameddine
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Division of Cardiology, Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
|
22
|
Emi M, Aoki H, Nakamura Y, Hirano Y, Takahashi K, Kayatani F. Rare accessory pathway between a giant left atrial appendage and the left ventricle. HeartRhythm Case Rep 2020; 6:131-134. [PMID: 32181130 PMCID: PMC7064796 DOI: 10.1016/j.hrcr.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Misugi Emi
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hisaaki Aoki
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Yoshihide Nakamura
- Department of Pediatrics, Kindai University, Faculty of Medicine, Osaka, Japan
| | - Yasuhiro Hirano
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kunihiko Takahashi
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Futoshi Kayatani
- Department of Pediatric Cardiology, Osaka Women's and Children's Hospital, Osaka, Japan
| |
Collapse
|
|
23
|
Wang X, Ren W, Xiao Y, Qiao W, Li Y, Cui L, Zhang X. A giant, well-differentiated papillary mesothelioma of the left atrioventricular groove: Case report and brief review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:564-567. [PMID: 31074511 DOI: 10.1002/jcu.22730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/19/2019] [Accepted: 04/21/2019] [Indexed: 06/09/2023]
Abstract
Of the primary cardiac tumors, well-differentiated papillary mesothelioma (WDPM) is very rare, with only one case report documenting WDPM of the pericardium. We report herein a 17-year-old boy who had an abnormal chest X-ray on a routine college-entrance examination. A giant cardiac tumor was detected by echocardiography. The neoplasm was partially resected, and histopathological examination revealed a WDPM. The patient recovered without any complication.
Collapse
Affiliation(s)
- Xin Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Weidong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yangjie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Qiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Li
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Li Cui
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xintong Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
|
24
|
Khanra D, Tiwari P, Kodliwadmath A, Duggal B. Giant left atrial appendage aneurysm and atrial fibrillation: chicken or the egg? BMJ Case Rep 2019; 12:12/8/e231300. [PMID: 31451479 DOI: 10.1136/bcr-2019-231300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dibbendhu Khanra
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pradyot Tiwari
- Cardiology, Apex Heart Institute, Ahmedabad, Gujarat, India
| | - Ashwin Kodliwadmath
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhanu Duggal
- Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|