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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. C ONGENITAL LEFT ATRIAL APPENDAGE ANEURYSM IS a very rare congenital heart disease, 1-7 with potentially lethal complications. 1-3 We report a case of congenital left atrial appendage giant aneurysm, leading to left ventricular compression and progressive mitral valve regurgitation, which was successfully operated off pump by means of surgical excision. Case reportA 3-month-old girl, with a body weight of 6.2 kilograms was referred to our department for surgical management of a giant compressive aneurysm of the left atrial appendage. The child was asymptomatic at birth, but a cardiac murmur was detected at routine physical examination. The chest roentogenogram showed a nonspecific cardiomegaly with an unusually prominent left heart border. Electrocardiogram showed regular sinus rhythm, with a heart rate of 146 beats per minute, and no episodes of arrhythmia or thromboembolism were ever reported. Soon after birth, a two-dimensional cross-sectional echocardiographic and Doppler examination revealed a large aneurysm of the left atrial appendage (45 3 60 millimetres), communicating with the left atrium through a large orifice (Fig 1).The patient was followed up clinically by serial echocardiographic examinations that showed progression of mitral regurgitation from mild to moderate. In addition, when compared with the first assessement, the most recent echocardiographic detections showed that the left ventricle was rightwardly dislocated, as if the enlarged atrial appendage was pushing on it. Thus, because of echocardiographic evidence of left ventricular dislocation and Figure 1. Two-dimensional echocardiographic four-chamber view, showing the giant aneurysm originating from the left atrium (RA 5 right atrium; RV 5 right ventricle; LV 5 left ventricle; LA 5 left atrium, LAA 5 left atrial appendage; arrow pointing at the LAA aneurysm).

Background & Objectives: To evaluate the advantages of the one and a half ventricle repair on maintaining a low pressure in the inferior vena cava district. Also evaluate the competition of flows at the superior vena cava – right pulmonary artery anastomosis site, in order to understand the hemodynamic interaction of a pulsatile flow in combination to a laminar one. Materials & Methods: Adult rabbits (n=30) in terminal anaesthesia with a follow up of 8 h were used, randomly distributed in three experimental groups: Group 1: animals with an anastomosis between superior vena cava and right pulmonary artery, as a model of one and one half ventricle repair; Group 2: animals with the cavopulmonary anastomosis followed by clamping of the right pulmonary artery proximal to the anastomosis; and Group 3: sham animals. Pressures of superior vena cava and pulmonary arteries were afterwards measured, in a resting condition as well as after induced pharmacological stress test.Results: In Group 1, superior vena cava pressure was significantly higher, while venous pressure in the inferior vena cava – right atrium district was constant or lower in comparison with the other groups. After stress test, the pressure in the superior vena cava and the heart rate both increased further, but the right ventricular, right atrial and pulmonary artery pressures remained similar to the values in a resting condition. This proved that the inferior vena cava return was well-preserved, and no venous hypertension was present in the inferior vena cava district even after stress test (good exercise tolerance).Conclusion: One and one half ventricle repair can be considered a good surgical strategy for maintaining a low pressure in the inferior vena cava district with potential for right ventricle growth, restoring the more physiological circulation in borderline or failing right ventricle conditions. The experiment presented a positive finding in favour of one and one half ventricle repair, as compared to Fontan type procedure.

Introduction: To observe how vacuum assisted venous drainage (VAVD) may influence the flow in a cardiopulmonary bypass circuit with different size of venous lines and cannulas. Methods: The experimental circuit was assembled to represent the cardiopulmonary bypass circuit routinely used during cardiac surgery. Wall suction was applied directly, modulated and measured into the venous reservoir. The blood flow was measured with a flow-meter positioned on the venous line. The circuit prime volume was replaced with group O date expired re-suspended red cells and Plasmalyte 148 to a hematocrit of 28% to 30%. Results: In an open circuit with gravity siphon venous drain, angled cannulae drain more than straight ones regardless the amount of suction applied to the venous line (16 Fr straight cannula (S) drains 90 ml/min less than a 16 Fr angled (A) with a siphon gravity). The same flow can be obtained with lower cannula size and higher suction (i.e. 12 A with and -30 mmHg). Tables have been created to list how the flow varies according to the size of the cannulas, the size of the venous tubes, and the amount of suction applied to the system. Conclusions: Vacuum assisted venous drainage allows the use of smaller cannulae and venous lines to maintain a good venous return, which is very useful during minimally invasive approaches. The present study should be considered as a preliminary attempt to create a scientific-based starting point for a uniform the use of VAVD. Keywords: cardio-pulmonary bypass; experimental study; vacuum assisted drainage.