When the left atrium becomes a monster: a case report

Abstract

Background Congenital left atrium (LA) aneurysms are extremely rare entities in clinical practice and most frequently involve the atrial appendage and rarely arise from the body of LA, We report a case of giant LA aneurysm compressing heart and presenting in a very late stage. Case summary A 31-year-old male, who was diagnosed to have dextrocardia, rheumatic heart disease, and atrial fibrillation and was kept on medical treatment long time ago, presented with congestive heart failure symptoms and cardiogenic shock. Emergency transthoracic echocardiography was done revealing situs solitus with aneurysmally dilated LA pushing heart to the right side (dextro-posed heart), moderate mitral regurgitation, and severe pulmonary hypertension, however, pulmonary artery anatomy could not be properly visualized so computed tomography (CT) was preformed confirming diagnosis and revealing compressed pulmonary arterial tree by the dilated LA, unfortunately patient died before proceeding to surgical intervention. Discussion Congenital left atrial aneurysms are extremely rare anomaly and may be associated with significant morbidity. And, therefore, should be remembered as a potential anatomic cause of atrial arrhythmias or embolic phenomena, or both. The diagnosis may be easily established through non-invasive complementary techniques, such as echocardiography, CT, and cardiac magnetic resonance imaging. Symptomatic patients, those with large aneurysm or compelling indications for surgery should undergo surgical resection.

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

“…It can, however, hardly in most cases show the connection and communication between the LA and the echo-free cavity and, therefore, cannot make the definite diagnosis of LAAA in many cases and sometimes make the diagnosis mistakenly as a pericardial cyst or effusion ( 3 , 17 ). Khaled A. Shams reported a case with aneurysmally dilated LA pushing the heart to the right side, and thus a dextro-posed heart was misdiagnosed as dextro-cardia with rheumatic heart disease and AF for a long time till the disease progressed to cardiogenic shock ( 29 ). Contrast-enhanced echocardiography can demonstrate the connection of LA and the cavity, which clearly shows the LAAA border, and more importantly the presence of a thrombus, which is a key element for therapeutic choice ( 21 ).…”

Congenital large aneurysmal left atrium: a rare cause of 100% cardiothoracic ratio

“…The majority of congenital or acquired cardiac diseases are routinely diagnosed by echocardiogram; however, a chest X-ray is frequently used as the initial imaging investigation. The correct interpretation of these radiographs allows for the most suitable work-up and care 1 2. Cardiothoracic ratio (CTR) was measured as ‘the ratio of the maximal transverse diameter of the cardiac silhouette to the distance between the internal rib margins at the level of the right hemidiaphragm’ 2 3…”

“…Non-invasive imaging procedures such as echocardiography, CT scan and cardiac MRI are used to make the diagnosis. These individuals should then be treated with the appropriate medical and surgical procedures 1…”

Surgical repair of a giant congenital left atrial aneurysm presenting with respiratory distress in a neonate

“…Congenital left atrial aneurysm (CLAA) is an extremely rare congenital cardiac anomaly with potential serious complications on long‐term basis such as arrhythmias, thromboembolic events, and myocardial dysfunction 1,2 . The first description of CLAA was introduced by Semans and Taussig in 1938 3 . Growth of CLAA may be attributed to dysplasia of the pectinate muscles which leads to poor myocardial contractility of the left atrium (LA), with resultant progressive LA dilatation 2,4,5 .…”

“…It is usually an isolated lesion, and the most common associated lesion is secondary mitral valve regurgitation (MR) 1,2 . The diagnostic modalities of CLAA consist of noninvasive imaging such as transthoracic or transesophageal echocardiography (TTE or TEE), computed tomography angiography(CTA), and magnetic resonance imaging (MRI) 1,3 . Despite the congenital origin of this condition, it may remain asymptomatic and patients may not present until their third decade of life, with very few reported cases of neonatal presentation 2,4 .…”