Congenital left atrial appendage aneurysm: A rare case report and literature review

Abstract

Rationale: Left atrial appendage aneurysms (LAAA) are rare. Patients with LAAA are often diagnosed incidentally or after cardiac tachyarrhythmia or systemic thromboembolism happen. Early diagnosis and surgical resection is of utmost importance to prevent hazardous adverse events.

Patient concerns: We present a case of 46-year-old man with congenital LAAA. The individual in this manuscript has given written informed consent to publish these case details.

Diagnoses: Imaging studies, such as echocardiography, cardiovascular computed tomography (CT) and magnetic resonance imaging (MRI), demonstrated the large cavity arising from the left atrial appendage. The diagnosis of LAAA was confirmed.

Interventions: The patient underwent an aneurysmectomy without any complications.

Outcomes: TTE confirmed the disappearance of the LAAA from the left parasternal short-axis view of the aortic root postoperatively. The patient remained asymptomatic without any adverse events at his 3-month follow-up visits.

Lessons: The associated high risk of life-threatening complications and the relative ease of surgical removal suggest that prompt evaluation should be considered in patients with lesions adjacent to the left heart border.

Figure 1

The posteroanterior chest x-ray demonstrating abnormal left heart border.

Figure 2

Transthoracic echocardiograms. Apical 3-chamber (A, B) and 4-chamber (C, D) views showing a 8.4 × 6.8 × 4.3-cm size mass communicating to LA and the presence of mild mitral regurgitation. AAO = ascending aorta, LA = left atrium, LAA = left atrial appendage, LV = left ventricle, RA = right atrium, RV = right ventricle.

Figure 3

Contrast echocardiograms. Apical 3-chamber (A) and 4-chamber (B) views confirming this mass (arrow) communicating to the LA. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.

Figure 4

Transesophageal echocardiograms. The mid-esophageal 2-chamber and LAA view (A) revealing a giant LAA. Color Doppler flow imaging (B) showing communication of flow between LAA and the LA. Pulsed wave Doppler (C) echocardiographic examination of blood flow at the orifice. Three-dimensional view (D) confirming the presence of giant LAA. LA = left atrium, LAA = left atrial appendage, LV = left ventricle, LUPV = left upper pulmonary vein.

Figure 5

CT views characterizing the giant LAA measuring 9.6 × 4.5 × 3.8 cm. AAO = ascending aorta, LA = left atrium, LAA = left atrial appendage, LV = left ventricle, RA = right atrium, RV = right ventricle, RAA = right atrial appendage.

Figure 6

MRI. Axial spin-echo T1-weighted (E) and Coronal spin-echo T1-weighted image (F) showing the LAA aneurysm with no evidence of thrombus. LA = left atrium, LV = left ventricle, MRI = magnetic resonance imaging, RA = right atrium, RV = right ventricle.

Figure 7

Intraoperative views (A–D) and histopathological pictures (E, F). The resected aneurysm measured 8.7 × 7.0 cm (C, D) through a limited left thoracotomy (A, B). Histopathological section of the aneurysm showing the myocardial thinning with fatty infiltration.