Abstract
Congenital left atrial aneurysm is a very rare congenital cardiac anomaly, and very few cases have been reported with neonatal presentation. Despite the congenital origin of this condition, it may remain asymptomatic and patients may not present until their third decade of life. Even in asymptomatic cases, prompt surgical intervention is indicated for the prevention of fatal thromboembolic events such as stroke. In neonates and infants presenting early in life, surgical intervention is urgent to relieve respiratory distress symptoms. Herein, we introduce the case of a 3-week-old neonate who presented with severe respiratory distress symptoms requiring prompt intubation and mechanical ventilation. Diagnosis of congenital left atrial aneurysm was established and confirmed by transthoracic echocardiography and computed tomography angiography. The patient underwent surgical resection of the aneurysm using cardiopulmonary bypass and cardiac arrest. The patient was discharged from the hospital after three weeks with normal echocardiography.
Introduction :
Congenital left atrial aneurysm (CLAA) is an extremely rare congenital cardiac anomaly with potential serious complications on long-term basis such as arrhythmias, thromboembolic events and myocardial dysfunction (1,2). The first description of CLAA was introduced by Semans and Taussig in 1938 (3). Growth of CLAA may be attributed to dysplasia of the pectinate muscles which leads to poor myocardial contractility of the left atrium (LA). This results in progressive dilatation of LA according to laplace law (2,4,5). It is usually an isolated lesion, and the most common associated lesion is secondary mitral valve regurgitation (1,2). It has been reported that diagnosis of CLAA depends on its origin from a normal LA and its location within the pericardium with well-defined communication with LA (6). The diagnostic modalities of CLAA consist of non-invasive imaging such as transthoracic or transesophageal echocardiography (TTE, TEE), computed tomography angiography(CTA), and magnetic resonance imaging (MRI) (1,3). Despite the congenital origin of this condition, it may remain asymptomatic and patients may not present until their third decade of life, with very few reported cases of neonatal presentation (2,4). Even in asymptomatic cases, prompt surgical intervention is indicated, for the prevention of fatal thromboembolic events such as stroke (1,2,7). In neonates and infants presenting early in life, surgical intervention is urgent to relieve respiratory distress symptoms (8). Herein we present a case of a 3-week-old neonate who presented with respiratory distress, and was diagnosed to have a giant CLAA. Successful surgical resection of the CLAA was performed as soon as the diagnosis was established .