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(Circulation. 2000;102:2282.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Recognition of Left Atrial Aneurysm by Fetal Echocardiography

Robin R. Fountain-Dommer, MD; Henry B. Wiles, MD; C. Osborne Shuler, MD; Scott M. Bradley, MD; Girish S. Shirali, MD

From Children’s Heart Center of South Carolina, Charleston (R.R.F.-D., H.B.W., C.O.S., S.M.B., G.S.S.), and the University of South Carolina School of Medicine, Columbia (C.O.S.).

Correspondence to Girish S. Shirali, MD, Medical University of South Carolina, 165 Ashley Avenue, PO Box 250915, Charleston, SC 29425. E-mail shiralig@musc.edu

A fetus was noted to have a mediastinal mass on prenatal ultrasound. Fetal echocardiography at 26 weeks of gestation demonstrated a large cystic structure adjacent to the left atrium and left ventricle (Figure 1). The baby was born full term. Echocardiography revealed a large, thin-walled aneurysm (3x3 cm) lateral to the left atrium and communicating with it through an orifice posterior to the base of the left atrial appendage. As determined by MRI, this aneurysm extended from the transverse aortic arch to the cardiac apex (Figure 2). Angiograms were obtained with the catheter tip positioned within the aneurysm (Figure 3). None of these imaging modalities revealed thrombus within the aneurysm.

View larger version (146K): [in this window] [in a new window]   Figure 1. Four-chamber fetal echocardiogram at 26 weeks of gestation reveals a large cystic structure lateral to the left atrium (LA) and left ventricle (LV). This structure appears to communicate with the left atrium. An indicates aneurysm.

View larger version (172K): [in this window] [in a new window]   Figure 2. Coronal T1-weighted MR spin echo image shows the aneurysm (An) on the lateral surface of the left ventricle (LV) and left atrium (LA). Significant signal is present within the aneurysm, indicating nonflowing fluid.

View larger version (162K): [in this window] [in a new window]   Figure 3. Angiogram with catheter tip in left atrial aneurysm (An). Communication between left atrium (LA) and aneurysm is evident. Left atrial appendage (LAA) is visible superior to and separate from the aneurysm.

At 29 days of age, the aneurysm was approached surgically through a median sternotomy under cardiopulmonary bypass; it appeared thin-walled and translucent and extended along the lateral aspect of the left ventricle (Figure 4). When . . . [Full Text of this Article]