Left atrial appendage aneurysm: A case report

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.

Case Report: Giant Congenital Left Atrial Appendage Aneurysm Presenting With Acute Massive Cerebral Infarction and Refractory Atrial Fibrillation: A Case Report and Literature Review

“…Interestingly, during the AF episode, the ST-segment elevation in the precordial leads was recorded. As previously reported, it was likely caused by embolic occlusion of a coronary artery ( 11 ) or by external compression of the coronary arteries by LAAA ( 20 , 25 , 26 ). In our case, the compression of the left coronary artery or its divisions was more likely since no elevation of serial myocardial injury biomarkers was recorded.…”

“…Recently, catheter closure of a giant LAAA was reported, providing a novel non-invasive approach to treating LAAA ( 3 ). Removal of the aneurysm usually results in complete resolution of atrial arrhythmias as seen in previous reports ( 20 , 39 ), although a concomitant full maze procedure was suggested in another study of LAAA with chronic AF. However, concomitant AF surgery may increase the risk of requiring a permanent pacemaker ( 40 ).…”

“…Congenital LAAA was firstly described in two children by Dr. Parmley in 1962 ( 19 ). Most studies about LAAA are individual case reports ( 4 , 8 , 13 ), and to date, about 150 cases of this defect have been reported in the literature ( 7 , 10 , 20 ). Although this disease is rare, its consequences are potentially hazardous and late diagnosis is common.…”

A rare case of left atrial appendage aneurysm

“…Compared with transthoracic ultrasound, transesophageal ultrasound can understand the internal structure of the heart more clearly and accurately and whether there are other organic or functional complications. [9] Chest CT and cardiopulmonary CTA can directly understand the anatomical structure, relative position and compression of atrial appendage aneurysms. Cardiac MRI and PET-CT are seldom used in clinic.…”

Left atrial appendage aneurysm resection following the onset of a cardiogenic stroke: a case report

“…Regarding intervention for atrial arrhythmia, some argue that intervention is unnecessary since the arrhythmia disappears when the aneurysm is removed [ 4 ], while others argue that intervention is necessary because it may not be possible to entirely remove the dysmorphic atrial tissue that causes the arrhythmia [ 5 ]. Although controversial, there is a report of atrial flutter after LAAA resection requiring catheter ablation [ 6 ]; thus intervention for arrhythmia may be considered. The full-maze procedure is more likely to achieve sinus rhythm; however, it prolongs the operative time.…”