Staged hybrid ablation in left atrial appendage aneurysm a rare cause of refractory atrial tachyarrhythmia-a case report.

Background: Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly, which can be congenital or acquired in origin. Because most cases are asymptomatic, it is typically diagnosed incidentally in the second to third decades of life. We present a case of a 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance. The informed consent was given by patient for this manuscript. Case summary: We present a case of a 28-year-old male with refractory atrial tachyarrhythmias and significantly reduced exercise tolerance after an episode of COVID respiratory infection. He was referred by primary care physician for management of atrial fibrillation (AF) with CHA2DS2Vasc score zero. He had documented AF and atrial flutter (AFL) resistant to both chemical and electrical cardioversions. Initial portable focused transthoracic echocardiography documented borderline reduced left ventricular ejection fraction in context of AFL. Electrophysiological study confirmed the diagnosis of typical AFL. Successful radiofrequency ablation of cavo-tricuspid isthmus resulted in bidirectional isthmus conduction block. However, patient developed AF, which was electrically cardioverted at the end of procedure. Patient was discharged on bisoprolol, ramipril, and apixaban, and outpatient cardiac MRI was organized to look for post-COVID myocardial scarring. Patient had recurrence of symptoms, and this time it was due to AF. Multimodal imaging led to discovery of LAAA, in which after discussion in multidisciplinary meeting, he was accepted for and managed with surgical resection of LAAA with concomitant Cox-Maze IV procedure. On 9 months post-operative follow up, patient is maintaining sinus rhythm and has completely returned to baseline activities. Discussion: A young patient with refractory atrial arrhythmia should be referred for multimodal cardiovascular imaging to rule out any structural heart disease. Left atrial appendage aneurysm is rare and can be managed conservatively, but surgical excision is most reported and appears to favour arrhythmia-free survival.

A rare case of left atrial appendage aneurysm.

BACKGROUND: Left atrial appendage aneurysm is a rare cardiac mass, with only a few cases reported. There are usually no specific symptoms, and a few patients visit the doctor with symptoms. CASE PRESENTATION: A 20-year-old male presented to our hospital with a "pericardial cyst found by medical evaluation in another hospital for 2 years." Cardiac ultrasound performed at clinics of our hospital suggested a cystic dark area in the left ventricular lateral wall and the anterior lateral wall, consistent with a pericardial cyst and mild mitral regurgitation. After further relevant examinations and ruling out contraindications, an excision of the left atrial appendage aneurysm was performed under general anesthesia and cardiopulmonary bypass with beating-heart. The postoperative pathological results identified that: (left atrial appendage) fibrocystic wall-like tissue with a focal lining of the flat epithelium, consistent with a benign cyst. CONCLUSION: Left atrial appendage aneurysms are rare and insidious. They are usually found by chance during medical evaluations. If the location is not good or the volume is too large, then compression symptoms or arrhythmia, thrombosis and other concomitant symptoms will occur. Surgical resection is presently the only effective radical cure for a left atrial appendage aneurysm.

Giant aneurysm of the left atrial appendage: a case report.

Background: Left atrial appendage aneurysm (LAAA) is a rare condition mostly due to congenital malformations or secondary causes (i.e. mitral regurgitation). Case summary: We present a case of a 47-year-old male with a history of atrial fibrillation treated with propafenone presented to our emergency department for palpitation and epigastric pain. The electrocardiogram showed atrial fibrillation at high ventricular rate and a new-onset left bundle branch block. Urgent coronary angiogram excluded coronary artery disease. Echocardiography and cardiac magnetic resonance revealed a giant LAAA. The electrocardiogram alterations were deemed secondary to aberrancy and treatment with class IC antiarrhythmic. The patient was discussed in the heart team, and considering his will to avoid surgery, he was managed conservatively with closed follow-up, anticoagulant and antiarrhythmic therapy, and internal loop recorder. At 1-year follow-up, he showed asymptomatic and without arrhythmias. Discussion: Few cases are described in the literature; therefore, there is uncertainty in treatment and prognosis. Diagnosis is achieved with multimodality imaging. Treatment can be surgical with aneurysmectomy or conservative with regular follow-up by imaging examinations and pharmacological therapy aimed to prevent complications such as thrombosis and arrhythmias. Since high-quality scientific data are lacking, shared decision-making is essential for the management of patients affected by LAAA. In our clinical case, our patient's will to not undergo surgery was considered, and therefore, a conservative management with strict follow-up and medications was chosen.

Imaging reveals a fifth heart chamber: Diagnosing and treating a massive left atrial appendage aneurysm.

In this case report, a 33-year-old male with a history of smoking presented with recurrent palpitations and chest discomfort. Holter monitoring revealed atrial flutter, and imaging showed a giant left atrial appendage aneurysm. Due to the risk of arrhythmias and thromboembolic events, surgical resection was performed successfully. This case underscores the importance of considering uncommon structural cardiac abnormalities in the evaluation of arrhythmia symptoms in young patients.

Case Report: One heart with two lobes: a rare infantile congenital giant left atrial appendage aneurysm.

Left atrial appendage aneurysm (LAAA) is an extremely rare congenital heart abnormality, with varying degrees of symptoms, ranging from asymptomatic to arrhythmia, thromboembolic event or airway obstruction. Most infantile cases were incidentally found by echocardiography. Contrast-enhanced chest tomography can confirm the diagnosis and inform surgical plan. We describe an asymptomatic young female infant who had a unique extreme cardiomegaly on a chest x-ray and received surgical aneurysmectomy. Her heart was restored to a normal cardiac size after the heart surgery.

Left atrial appendage aneurysm in pediatrics: Case study and literature review.

Left atrial appendage aneurysm (LAAA) is a rare cardiac pathology that is often identified in adulthood. There are a myriad of presentations related to atrial appendage enlargement, but most are asymptomatic. Pediatric cases of LAAA are extremely rare. We report a case of an incidental giant LAAA found in a healthy 6-year-old boy. He was successfully treated with surgical resection. A review of the literature shows that the presentation of LAAA in pediatrics likely involves cardiac or respiratory symptoms but can also be incidental findings. Similar to adults, diagnosis requires cardiac imaging, with echocardiography being the mainstay. Surgical intervention is indicated in symptomatic and most asymptomatic patients to prevent complications. More research is warranted into the optimal timing of surgery and alternative surgical approaches for complex cases.

Radiofrequency ablation-induced superior vena cava stenosis in a 5-year-old boy with congenital left atrial appendage deformity: a case report and literature review.

Superior vena cava (SVC) stenosis is rarely caused by iatrogenic trauma. Herein, the case of a 5-year-old boy who underwent radiofrequency ablation for paroxysmal supraventricular tachycardia but developed SVC stenosis and related syndromes is reported. Notably, the child exhibited an enlarged left atrial appendage that had partially breached the pericardium. Subsequent interventions involved successful removal of the stenosis, artificial vascular reconstruction, and comprehensive radiofrequency ablation of the entire right atrium, along with ligation of the left atrial appendage under direct vision. As a result, the child experienced relief from symptoms.

A PREGNANT WOMAN WITH AN EXTRA CARDIAC CAVITY: AN ACQUIRED IATROGENIC COMPLICATION - A CASE REPORT AND LITERATURE REVIEW.

According to the modified World Health Organization (WHO) classification, mechanical valves pose a high maternal risk and complications for pregnant women with heart disease. Left atrial appendage aneurysm (LAAA) is a rare condition that can manifest clinically in several ways or remain silent for a long time and can be either congenital or acquired. We present the case of a pregnant woman who had a LAAA discovered several years after her last mitral valve replacement. LEARNING POINTS: Left atrial appendage aneurysm is a rare entity and, in most cases, is congenital due to poor myocardial contractility of dysplastic pectinate muscles.Clinical manifestations range from an asymptomatic course with an incidental finding on echocardiography up to serious sequelae such as cardioembolic manifestations.The treatment approach includes a conservative strategy using anticoagulation and a surgical strategy with aneurysmectomy.

Left atrial appendage aneurysm in newborns: a report of two cases.

Left atrial appendage aneurysm is an extremely rare cardiac anomaly with serious complications. It is rarely diagnosed in childhood. Herein, we reported two newborns diagnosed with left atrial appendage aneurysm.

A giant left atrial appendage aneurysm with recurrent chest tightness and atrial tachycardia: Multimodal imaging findings.

Left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly that is usually incidentally found in middle-aged patients. Though initially asymptomatic, LAAA can cause some serious complications: atrial tachyarrhythmia, thromboembolism, peripheral compression, and cardiac dysfunction. Multimodal imaging technologies, especially echocardiography and computed tomography (CT) scanning play an important role in the diagnosis of LAAA. Transthoracic echocardiography (TTE) is generally used for preliminary evaluation and diagnosis of the aneurysm. CT scanning can further confirm the diagnosis by demonstrating the spatial structure relationships and eliminating the possibility of other cardiac tumors. The following case study pertains to a 54-year-old patient with recurrent chest tightness and atrial tachycardia. The patient was diagnosed with a giant LAAA by multimodal imaging technology, and the aneurysm was surgically removed under cardiopulmonary bypass. After 4 years of follow-up, the patient reported living a healthy life without chest discomfort, complications, or medication. Multimodal imaging can provide important information for the diagnosis and treatment of left atrial appendage aneurysms, and aneurysm resection can be an effective therapeutic approach with a good long-term prognosis.

Left atrial appendage aneurysm enlarged in the neonatal period.

We describe a newborn with a congenital left atrial appendage aneurysm. The aneurysm size did not change prenatally. However, it rapidly enlarged after birth. MRI was useful for assessing the aneurysm extent and exact size, and for diagnosis. Respiratory distress and feeding difficulties appeared, and surgery was performed. These symptoms disappeared post-operatively. The patient is alive without complications or recurrence.

Left Atrial Appendage Aneurysm: A Case Report.

Left atrial appendage aneurysm (LAAA) is a rare heart anomaly caused by congenital dysplasia of the pectinate muscle or by an acquired pathological condition of the mitral valve or cardiac muscle. It is often incidentally discovered during chest CT or echocardiography as an abnormal dilatation of the LAA. LAAA is associated with life-threatening complications and most patients require surgical treatment. Therefore, it is important to evaluate associated complications as well as precise diagnoses. This report presents the case of a surgically confirmed LAAA in a 53-year-old female. We also discuss the pathophysiology of LAAA and significant findings related to mortality that can be detected on CT and MRI.

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

Background: Congenital left atrial appendage aneurysm (LAAA) is a rare cardiac anomaly with a variety of presentations, from being asymptomatic to potentially serious complications such as systemic thromboembolism and atrial tachyarrhythmia. Case Presentation: We report a case of congenital giant LAAA in a 35-year-old man presenting with acute massive cerebral infarction and atrial fibrillation (AF) with rapid ventricular rate. The AF was refractory to conventional antiarrhythmic agents, such as amiodarone and electrical cardioversion, but restored and maintained sinus rhythm after surgical resection of LAAA. The patient remained free of events and was in sinus rhythm during half-year follow-up. Conclusion: Giant LAAA has the potential causing serious complications and should be managed surgically in most cases.

The left atrial appendage congenital aneurysm in a two-year-old child: a case report.

The left atrial appendage congenital aneurysm is an extremely rare heart defect. The entity can remain asymptomatic for a long time; however, it may lead to life-threatening morbidity or death.

Prenatal and postnatal echocardiography evaluation of left atrial appendage aneurysm / 中国医师杂志

Objective:To summarize the ultrasonophic features of left atrial appendage aneurysm, and to provide an important reference for the early and accurate diagnosis of left atrial appendage aneurysm.Methods:Patients with atrial appendage aneurysm have no obvious symptoms in the early stage, and there are many difficulties and challenges in diagnosis. This paper analyzed and summarized the diagnostic characteristics of a child with left atrial appendage aneurysm by combining the prenatal and postnatal ultrasonic imaging characteristics.Results:Echocardiography is the first choice for the diagnosis of left atrial appendage aneurysm. Some cases can make precise diagnosis prenatally.Conclusions:Echocardiography is the preferred imaging examination method for evaluating left atrial appendage aneurysm. Multimodal imaging technology can identify and diagnose left atrial appendage aneurysm early and accurately, and provide important basis for clinical diagnosis and treatment plan.

Giant aneurysm of the left atrial appendage: A case report of a rare cause of dyspnea in a 55-year old woman.

INTRODUCTION: Congenital aneurysm of the left atrial appendage (LAAA) is a very rare heart with potentially serious and life-threatening complications. Diagnosis is difficult because of the asymptomatic forms, until complications arise. Early surgery is the treatment of choice, but the recommendation today remains unclear. CASE REPORT: We present a case of congenital giant left atrial appendage aneurysm (LAAA), in a 55-year-old, woman, without any medical or surgical history, who presented with dyspnea, in whom transthoracic echocardiograhpy demonstrated the presence of a giant left atrial aneurysm with thickening of the small mitral valve, a chest scan confirmed the diagnosis of LAAA and a myocardial magnetic resonance imaging revealed the presence of thickened mitral valve with bi-valvular balloonization and annular disjunction, thickening of the basal segments of the inferior and lateral wall, left atrial aneurysm with a dilated right coronary artery. Coronary angiography showed a tortuous coronary artery with a loop in the second segment without any significant stenosis. The patient is currently awaiting surgery. CONCLUSION: Left atrial appendage aneurysm is a serious illness will likely require years of medical care and follow up in the absence of surgical treatment. The choice and timing of surgical, conservative or catheter treatment always remains a challenge. Our case report shows that medical treatment is a safe approach that will delay or avoid surgery.

Prenatally diagnosed left atrial appendage aneurysm with various postnatal imaging investigations: A case report.

A congenital left atrial appendage aneurysm (LAAA) is a rare cardiac malformation, that is, usually diagnosed in adulthood. It is rarely diagnosed prenatally. In most cases, surgical resection is recommended soon after the diagnosis has been made due to the risk of arrhythmia and thrombotic events. The present report describes a case of LAAA that was prenatally diagnosed and was asymptomatic postnatally. Imaging revealed the relation of the cardiac and airway structures around the LAAA in detail. The patient underwent surgical resection of the LAAA successfully at 7 months of age and is currently healthy at 5 years of age.

Safe treatment of congenital left atrial appendage aneurysm using lateral thoracotomy on a 3-year-old patient.

Limited literatures report the management of congenital left atrial appendage aneurysm (LAAA) which is extremely rare. Chest X-ray firstly showed an enlarged left cardiac silhouette for a 3-year-old patient with pneumonia. Echocardiography and magnetic resonance imaging confirmed a large cyst attached to the left atrium. Aneurysmectomy was performed through lateral thoracotomy using step-by-step method and under the guidance of transoesophageal echocardiography. We aim to show the safety and efficacy of this approach applied to children associated with congenital LAAA.

Blood Flow Dynamics in a Giant Left Atrial Appendage Aneurysm Visualized by 4D-Flow CMR.

Aneurysms of the left atrial appendage (LAA) are rare entities that often require surgical intervention. We demonstrate multimodality imaging features of a giant LAA aneurysm, with a focus on 3-dimensional blood flow dynamics by using 4-dimensional-flow cardiac magnetic resonance. (Level of Difficulty: Advanced.).