Project description:Two years previously, a 73-year-old man with mitral regurgitation underwent mitral annuloplasty and left atrial appendage (LAA) exclusion by suturing the orifice from the endocardium. However, the mitral regurgitation became exacerbated, and the left atrium enlarged rapidly over a 6-month period. Computed tomography showed a heterogenic mass in the LAA, and coronary angiography revealed a coronary artery-LAA fistula. Reoperation revealed a thrombus filling the appendage and two small orifices of the coronary artery-LAA fistula located in the endocardium of the appendage. We excised the LAA and closed these fistula orifices concomitant with mitral valve replacement.
Project description:BackgroundLeft atrial appendage aneurysm (LAAA) is a rare condition mostly due to congenital malformations or secondary causes (i.e. mitral regurgitation).Case summaryWe 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.DiscussionFew 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.
Project description: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.
Project description: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.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.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.The patient underwent an aneurysmectomy without any complications.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.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.
Project description:Left atrial appendage occlusion device (LAAO) implantation among patients who have had coronary artery bypass grafting can be challenging. We report a case of scheduled LAAO device implantation that was aborted due to the anomalous course of a bypass graft that appeared to be adherent to the left atrial appendage. (Level of Difficulty: Intermediate.).
Project description:BackgroundPericardial effusion is a common complication of percutaneous left atrial appendage (LAA) closure. Acute management is the cornerstone of pericardial effusion treatment and interrupting the intervention is often required.Case summaryA 65-year-old man presented an acute 10 mm pericardial effusion following pigtail contrast appendage injection. A rapid Watchman Flex 24 mm (Boston Scientific) deployment permitted bleeding interruption. A needle pericardiocentesis was achieved in order to prevent any haemodynamical instability.DiscussionThis case report describes an atypical cause of pericardial effusion and a technique for bleeding control with LAA closure device deployment.
Project description: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.