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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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INTERESTING IMAGE Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 1  |  Page : 51-52
Congenital left atrial appendage aneurysm


1 Department of Cardiac Anaesthesia, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India
2 Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India
3 Department of Cardiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029, India

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How to cite this article:
Selvaraj T, Kapoor PM, Murali Krishna T, Kiran U, Chowdhury U, Seth S. Congenital left atrial appendage aneurysm. Ann Card Anaesth 2008;11:51-2

How to cite this URL:
Selvaraj T, Kapoor PM, Murali Krishna T, Kiran U, Chowdhury U, Seth S. Congenital left atrial appendage aneurysm. Ann Card Anaesth [serial online] 2008 [cited 2019 Nov 19];11:51-2. Available from: http://www.annals.in/text.asp?2008/11/1/51/38452



   Case Report Top


A 28-year-old female presented to the hospital with dyspnoea, chest pain and palpitation for the last one year. Electrocardiogram revealed atrial flutter with fast ventricular response. Chest X-ray showed cardiomegaly with prominent convexity of the left basal aspect of cardiac silhouette [Figure - 1]. Medical therapy was initiated with oral digoxin (0.25 mg once daily), metoprolol (37.5 mg once daily) and amiodarone (100 mg once daily). Echocardiography showed dilated left atrium, herniating aneurysmal left atrial appendage (LAA) (8 cm 8 cm 5 cm), thrombus in the LAA (2.5 3.3 cm) and in the left ventricle (1.2 1.4 cm). The patient had recurrent episodes of thromboembolism to right popliteal artery and received heparin infusion 600 IU/h. During the admission, the patient developed left-sided hemiplegia and aphasia, which was diagnosed as transient ischemic attack in view of the normal computerized tomographic scan of the brain. The patient recovered completely from it. The thrombus in the LAA and the left ventricle resolved. The LAA was excised through midsternotomy under cardiopulmonary bypass [Figure - 2]. The perioperative transoesophageal echocardiography (TOE) showed no residual thrombus. The postoperative course was uneventful.

Congenital left atrial appendage aneurysm is a very rare condition; literature search shows only twenty such reports. It usually presents in the second or third decade of life [1] and may be intra- or extrapericardial. [2] The surgical resection of the LAA is the preferred mode of therapy. [3] Extrapericardial type is usually associated with a congenital defect in the pericardium. Intrapericardial type presents with intact pericardium (as observed in our case). The stasis of blood in the aneurysm leads to the formation of thrombus and systemic embolisation. Echocardiography is usually diagnostic of this condition. In this case, intraoperative TOE [Figure - 3] is a useful aid to look for residual thrombus and to assess the adequacy of resection.

 
   References Top

1.Kiaii B, Doll N, Kuehl M, Mohr FW. Minimal invasive endoscopic resection of a giant left atrial appendage aneurysm. Ann Thorac Surg 2004;77:1437-8.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Pome G, Pelenghi S, Grassi M, Vignati G, Pellegrini A. Congenital intrapericardial aneurysm of the left atrial appendage. Ann Thorac Surg 2000;69:1569-71.  Back to cited text no. 2    
3.Bramlet DA, Edwards JE. Congenital aneurysm of left atrial appendage. Br Heart J 1981;45:97-100.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Poonam Malhotra Kapoor
Department of Cardiac Anaesthesia, 7th Floor, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.38452

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  [Figure - 1], [Figure - 2], [Figure - 3]



 

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