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Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 318-319
Left atrial band: A rare congenital anomaly


Department of Cardiology, Eastern Heart Clinic, Prince of Wales Hospital, Randwick, Sydney, Australia

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Date of Submission04-Mar-2014
Date of Acceptance21-Apr-2014
Date of Web Publication1-Oct-2014
 

   Abstract 

Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra-operative transesophageal echocardiogram and characterize its appearance on two-dimensional and three-dimensional echocardiograms.

Keywords: Transesophageal echocardiography; Three-dimensional echocardiogram; Left atrial band

How to cite this article:
Liou K, Premaratne M, Mathur G. Left atrial band: A rare congenital anomaly. Ann Card Anaesth 2014;17:318-9

How to cite this URL:
Liou K, Premaratne M, Mathur G. Left atrial band: A rare congenital anomaly. Ann Card Anaesth [serial online] 2014 [cited 2019 Nov 20];17:318-9. Available from: http://www.annals.in/text.asp?2014/17/4/318/142077



   Introduction Top


Left atrial fibromuscular band is a rare congenital anomaly, which exists in a small proportion of the general population. Although its clinical significance remains largely unknown, it is generally considered a benign entity. We present a patient with an incidental finding of a left atrial band, which caused a great deal of anxiety among treating clinicians due to the unusual appearance on the patient's intra-operative transesophageal echocardiogram (TEE).


   Case report Top


A 44-year-old male was referred to our institution for a coronary bypass surgery after he was diagnosed with significant double vessel disease following investigations for unstable angina. He was otherwise well with no documented co-morbidities. His preoperative transthoracic echocardiogram was unremarkable. During the routine intra-operative TEE, an abnormal linear structure was identified within the left atrium, which had the appearance of a pair of "tram track lines" [Figure 1]. It was thought this may have been a part of a catheter from the patient's coronary angiogram performed 2 days earlier, although there were no documented complications associated with this patient's previous coronary catheterization, and he had remained well. Notwithstanding, given the unusual nature of this finding, the cardiologist was alerted and consulted for review. Cardiology assessment confirmed the presence of a linear band stretching across the left atrium in close proximity to the mitral annulus [Figure 1]. There was no associated mitral regurgitation or stenosis. Similarly, there was also no evidence of color flow across the inter-atrial septum. In the absence of other reasonable explanations, the echo finding was considered consistent with a congenital left atrial band. However, as the patient was already on cardiopulmonary bypass, the operating surgeon elected to open the left atrium to explore this further. A 20 mm smooth band was identified in the left atrium with no other associated structural abnormalities. The band was subsequently excised. The surgery and patient's postoperative recovery were uneventful. The histopathological examination of the excised surgical specimen confirmed the presence of fibromuscular tissues within the band, which is consistent with a congenital left atrial band.
Figure 1: Two-dimensional (upper) and three-dimensional (lower) transesophageal echocardiogram depiction of the left atrial band in mid esophageal long axis view

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   Discussion Top


Congenital left atrial band is a rare finding and has an estimated prevalence of 2% based on an autopsy study. [1] It originates from the left atrial side of the fossa ovalis, and terminates in other areas within the left atrium. [1] At our institution, we have performed over 20,000 TEE in the last 20 years. This was the first case we have seen of this congenital abnormality. While the presence of a left atrial band appears to have no clinical significance in the majority of cases, mitral regurgitation due to tethering of the leaflet [2] as well as a possible link to cryptogenic stroke has been reported. [3] Further association between left atrial band and the presence of patent foramen ovale and the Chiari network have been reported, while increased prevalence of premature atrial complex have also been observed. [1] Left atrial band has a characteristic appearance on echocardiogram as illustrated by this case, and it is our intention to raise clinicians' awareness to this unique congenital anomaly by characterizing it on two-dimensional and three-dimensional echocardiograms.

 
   References Top

1.Yamashita T, Ohkawa S, Imai T, Ide H, Watanabe C, Ueda K. Prevalence and clinical significance of anomalous muscular band in the left atrium. Am J Cardiovasc Pathol 1993;4:286-93.  Back to cited text no. 1
    
2.Baran T, Küçükoðlu MS, Okçün B, Cetin G, Hatemi AC, Uner S. A rare cause of mitral insufficiency: Left atrial anomalous band. Echocardiography 2003;20:83-5.  Back to cited text no. 2
    
3.Ozer O, Sari I, Davutoglu V, Yigiter R, Akkoyun C. Cryptogenic stroke in two cases with left atrial band: Coincidence or cause? Eur J Echocardiogr 2009;10:360-1.  Back to cited text no. 3
    

Top
Correspondence Address:
Kevin Liou
Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick 2031, Sydney
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.142077

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