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Left Atrial Appendage Aneurysm
IMAGES
IN THE
MEDICAL SCIENCES
Left Atrial Appendage Aneurysm Yu-Huei Li, MD and Wen-Yu Lin, MD* *Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
57-year-old woman presented to our emergency department with intermittent episodes of palpitations, which began abruptly without significant precipitants and resolved spontaneously. Physical examinations showed a rapid heart rate of 130 beats per minute approximately, with irregular pattern; the remainder was unremarkable. She was otherwise healthy, without history of panic disorders or cardiovascular diseases. No remarkable family history was reported. She did not take medicine and did not use illicit drugs, alcohol or tobacco. No emotional stress was noted recently. An electrocardiogram showed atrial fibrillation with rapid ventricular responses. The patient received transthoracic echocardiography initially in our emergency department, and the preliminary findings showed no significant structural abnormalities. Surprisingly, the chest x-ray revealed a bulky mass, obliterating the left cardiac border (Figure 1A, arrow). Under the impression of possible structural heart disease, advanced computed tomography of the chest confirmed a large aneurysm (Figure 1B, arrow), arising from the left aspect of atrium (Figure 1B, asterisk). Blood testing showed normal serum thyroid-stimulating hormone and electrolyte levels. The patient underwent an aneurysmectomy. After surgery, the patient recovered and was discharged uneventfully, with a regular sinus rhythm and resolution of symptoms.
The American Journal of the Medical Sciences
Left atrial appendage aneurysm is an extremely rare cardiac disorder. The etiology can be congenital, characterized by dysplasia of the atrial muscle, or acquired, secondary to chronic cardiac diseases.1 Because the size of the aneurysm increases as the patient ages, the symptoms usually arise after the second decade of life.1 The clinical presentations included supraventricular arrhythmias (mostly atrial fibrillation), intracardiac thrombus, heart failure due to compression of the pulmonary venous drainage, chest pain secondary to compression of the coronary arteries and systemic embolism, especially cerebral embolism.1 The most serious and lethal complication of atrial fibrillation is stroke as a result of thromboembolism emanating mostly from the left atrial appendage. Surgical resection of the atrial appendage aneurysm, even in asymptomatic cases, is the preferred and recommended treatment.1,2 REFERENCES 1. Chowdhury UK, Seth S, Govindappa R, et al. Congenital left atrial appendage aneurysm: a case report and brief review of literature. Heart Lung Circ 2009;18:412–6. 2. Nakai Y, Asano M, Nomura N, et al. Surgical management of an aneurysm of the left atrial appendage to prevent potential sequelae. Interact Cardiovasc Thorac Surg 2013;17:586–7.
Volume 350, Number 2, August 2015
129
IN THE
MEDICAL SCIENCES
Left Atrial Appendage Aneurysm Yu-Huei Li, MD and Wen-Yu Lin, MD* *Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (E-mail: [email protected]) The authors have no financial or other conflicts of interest to disclose.
FIGURE 1
A
57-year-old woman presented to our emergency department with intermittent episodes of palpitations, which began abruptly without significant precipitants and resolved spontaneously. Physical examinations showed a rapid heart rate of 130 beats per minute approximately, with irregular pattern; the remainder was unremarkable. She was otherwise healthy, without history of panic disorders or cardiovascular diseases. No remarkable family history was reported. She did not take medicine and did not use illicit drugs, alcohol or tobacco. No emotional stress was noted recently. An electrocardiogram showed atrial fibrillation with rapid ventricular responses. The patient received transthoracic echocardiography initially in our emergency department, and the preliminary findings showed no significant structural abnormalities. Surprisingly, the chest x-ray revealed a bulky mass, obliterating the left cardiac border (Figure 1A, arrow). Under the impression of possible structural heart disease, advanced computed tomography of the chest confirmed a large aneurysm (Figure 1B, arrow), arising from the left aspect of atrium (Figure 1B, asterisk). Blood testing showed normal serum thyroid-stimulating hormone and electrolyte levels. The patient underwent an aneurysmectomy. After surgery, the patient recovered and was discharged uneventfully, with a regular sinus rhythm and resolution of symptoms.
The American Journal of the Medical Sciences
Left atrial appendage aneurysm is an extremely rare cardiac disorder. The etiology can be congenital, characterized by dysplasia of the atrial muscle, or acquired, secondary to chronic cardiac diseases.1 Because the size of the aneurysm increases as the patient ages, the symptoms usually arise after the second decade of life.1 The clinical presentations included supraventricular arrhythmias (mostly atrial fibrillation), intracardiac thrombus, heart failure due to compression of the pulmonary venous drainage, chest pain secondary to compression of the coronary arteries and systemic embolism, especially cerebral embolism.1 The most serious and lethal complication of atrial fibrillation is stroke as a result of thromboembolism emanating mostly from the left atrial appendage. Surgical resection of the atrial appendage aneurysm, even in asymptomatic cases, is the preferred and recommended treatment.1,2 REFERENCES 1. Chowdhury UK, Seth S, Govindappa R, et al. Congenital left atrial appendage aneurysm: a case report and brief review of literature. Heart Lung Circ 2009;18:412–6. 2. Nakai Y, Asano M, Nomura N, et al. Surgical management of an aneurysm of the left atrial appendage to prevent potential sequelae. Interact Cardiovasc Thorac Surg 2013;17:586–7.
Volume 350, Number 2, August 2015
129