Discussion:
CLAA is a very rare entity in neonates with 70% of cases being left atrial appendage aneurysms, and the remainder are left atrial aneurysms (1). In neonates and infants, the early presentations of the lesion may be attributed to the secondary MR, and airway obstruction which may result in heart failure and respiratory distress syndrome (2,8). Even in asymptomatic patients, surgery is mandatory due to the potential life threatening complications, or the compression of the adjacent cardiac and respiratory structures (2,5). According to previous reports, the risk of complications increases as the size of CLAA increases (9). Surgery is the treatment of choice and there are multiple surgical approaches including median sternotomy with or without CPB, endoscopic resection, left thoracotomy, and mini thoracotomy (4,6) The surgical intervention through median sternotomy and with CPB is the preferred one. This is because it enables the surgeon to perform the aneurysmectomy and mitral valve repair if there is any distortion of the valve (2).
To the best of our knowledge there are only four reported cases of neonatal surgical management of congenital left atrial aneurysms (one was LA aneurysm, and three were LA appendage aneurysms). Our case is very unique for two reasons: the first, it represents the smallest age at which CLAA was surgically managed, the second it is the largest LA aneurysm ever presenting in a neonate. Moreover, it had a sessile nature, and extended to the posterior wall of LV adjacent to marginal arteries.