Cardiac CT assessment of left atrial accessory appendages and diverticula.

OBJECTIVE: The purpose of this study is to describe the prevalence, morphology, size, and location of left atrial abnormalities including diverticula and accessory appendages in consecutive patients undergoing cardiac-gated CT for coronary artery evaluation. MATERIALS AND METHODS: Routine retrospectively gated contrast-enhanced 64-MDCT angiography (0.75-mm collimation, 330-milliseconds gantry rotation time) was performed in 529 consecutive patients. CT data sets were evaluated using axial, sagittal, coronal, and interactive multiplanar reconstructions; maximum intensity projections (MIPs); and interactive volume rendering. The presence, type, and location of left atrial appendages and diverticula were recorded. RESULTS: One hundred twenty-one patients had left atrial accessory appendages (n = 20) or left atrial diverticula (n = 81) or both (n = 20). One hundred four left atrial diverticula were found in 101 of the 529 patients (20%) and 44 accessory appendages in 41 patients (8%). Of the atrial diverticula, 88% were superior and anterior, 9% were right lateral superior, and 3% were inferior. Of accessory appendages, 34% were inferior posterior, 32% were left inferior, 18% were superior anterior, 14% were inferior posterior, and 2% were right inferior posterior. The average sizes of diverticula were 6.4 +/- 2.5 x 6.2 +/- 2.4 mm, and accessory appendages were 4.9 +/- 2.1 x 3.9 +/- 2.4 mm. CONCLUSION: Left atrial diverticula and accessory appendages are commonly found on cardiac-gated CT.

Coexistent congenital aortic defects, aneurysm of sinus of valsalva, atrial septal defect and infective endocarditis: a case report.

Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09%. They are associated in 10% of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.

Bilobulated atrial myxoma originating from low interatrial septum.

Myxomas are the most common type of primary cardiac tumors. Around 70% of patients who have them are females, 86% occur in the left atrium and more than 90% are solitary. In the left atrium the usual site of attachment is in the fossa ovalis. Less common sites within the left atrium are the mitral valve or in areas near it. This patient, with a left atrial myxoma originating low in the interatrial septum near the mitral valve, is one of the first cases reported in Puerto Rico. The patient is a 41 year old female with no previous history of systemic illnesses who one month prior to admission developed episodes of chest pain and shortness of breath. A 2D echo, done by a local physician, revealed a mobile left atrial mass causing diastolic obstruction of the valve. She was referred to our institution for further evaluation. A transesophageal echo was done showing a large bilobulated mass connected to the lowermost portion of the atrial septum, close to the mitral annulus, specially to the anterior leaflet. It also showed concurrent mitral regurgitation caused by the mass. The tumor was successfully resected without major complications and it was proven to be connected to the septum 1 cm above the mitral annulus. Pathological examination confirmed it to be a myxoma.

Update on pulmonary embolism.

Pulmonary embolism is a medical condition frequently overlooked in patients who present clinical symptoms that may suggest other more common cardiovascular conditions. As a result, missing such a diagnosis may unfortunately cost many lives. In this article the pathogenesis, etiologies and clinical features of this illness is reviewed. The diagnostic tools as well as the medical treatment available at hand today in the management of this condition is also discussed.