Circulation. 2006;114:e511-e512
doi: 10.1161/CIRCULATIONAHA.105.611236
(Circulation. 2006;114:e511-e512.)
© 2006 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Giant Compressive Aneurysm of the Left Auricle in a 1-Day-Old Neonate
Thomas Strecker, MD;
Andreas Koch, MD;
Ralf L. Schild, MD;
Helmut Singer, MD;
Michael Weyand, MD;
Albrecht Reimann, MD
From Center of Cardiac Surgery (T.S., M.W., A.R.), Department of Paediatric Cardiology, University Hospital for Children and Adolescents (A.K., H.S.), and Department of Obstetrics and Gynecology (R.L.S.), Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
Correspondence to Dr. Thomas Strecker, Center of Cardiac Surgery, Friedrich-Alexander-University of Erlangen-Nuremberg, Krankenhausstr. 12, D-91054 Erlangen, Germany. E-mail thomas.strecker{at}herz.imed.uni-erlangen.de
A 1-day-old boy who had been born at 40 weeks’ gestation weighing 3570 g was referred to our hospital for surgical resection of a giant compressive aneurysm of the left auricle. Fetal echocardiography at 34 weeks’ gestation had shown a large cavern structure lateral to the left atrium and left ventricle (Figure 1). At birth, the newborn was asymptomatic, and clinical examination was otherwise unremarkable. Immediate postnatal transthoracic echocardiography revealed a 30x35-mm large thrombotic aneurysm of the left auricle communicating with the left atrium through an orifice (Figure 2 and online-only Data Supplement). Because of the progressive compression of the left ventricle and the occurrence of an intracardiac thrombus, an early surgical management was required.
View larger version (85K):
[in this window]
[in a new window]
|
Figure 1. Four-chamber fetal echocardiography at 34 weeks’ gestation revealed a giant cavern structure lateral to the left atrium (LA) and the left ventricle (LV). This structure compressed the LV. The size of the cavern structure was 33x16 mm.
|
|
View larger version (94K):
[in this window]
[in a new window]
|
Figure 2. Immediate postnatal transthoracic echocardiography confirmed the large structure lateral of the left atrium (LA) and the left ventricle (LV). This structure appeared to communicate with the LA through an orifice, indicating an aneurysm within nonflowing thrombotic fluid.
|
|
Cardiopulmonary bypass was performed via aorto-bicaval cannulation with moderate hypothermia. Intraoperatively, there was a huge aneurysmatic sac of the left auricle that compromised the left ventricle (Figure 3). The aneurysmal left auricle was completely resected (Figure 4). At the end of surgery, the young patient was transferred to the intensive care unit in a stable hemodynamic condition. Histological examination of the resected tissue revealed recent thrombotic material without evidence of malignancy (Figure 5).
View larger version (168K):
[in this window]
[in a new window]
|
Figure 3. Intraoperative photograph taken before opening the aneurysm, showing the giant compressive and thrombotic aneurysm of the left auricle. PA indicates pulmonary artery; RV, right ventricle.
|
|
View larger version (112K):
[in this window]
[in a new window]
|
Figure 4. Intraoperative photograph showing the inside of the aneurysmal sac after excision of the thrombus. IVC indicates inferior vena cava.
|
|
View larger version (128K):
[in this window]
[in a new window]
|
Figure 5. Histology of the resected tissue of the left auricle. There was recent thrombotic material inside the aneurysm. The wall is composed of fibrous tissue and severely attenuated myocardial fibers (hematoxylin and eosin stain, x12).
|
|
Postoperatively, the neonate’s cardiopulmonary status progressively deteriorated over the subsequent 12 hours. The boy was placed on venoarterial extracorporal membrane oxygenation for a period of 9 days. The boy’s further postoperative recovery was uneventful. Before the patient left the hospital 1 month after surgery, echocardiography showed a normal-sized left ventricle with completely recovered function, good contractility, normal heart valves, and no relevant pericardial effusion. A repeated echocardiography 12 months after surgery showed similar results, with normal left ventricular function (Figure 6 and online Data Supplement).
View larger version (102K):
[in this window]
[in a new window]
|
Figure 6. Transthoracic echocardiography 1 year after surgery showing normal right and left ventricular function, good contractility of all areas, normal heart valves, and no relevant pericardial effusion. LV indicates left ventricle; LA, left atrium.
|
|
 |
Acknowledgments
|
|---|
Disclosures
None.
|
Footnotes
|
|---|
The online-only Data Supplement, which contains 6 movies, can be found at http://circ.ahajournals.org/cgi/content/full/114/13/e511/DC1.
Related Article:
-
Issue Highlights
Circulation 2006 114: 1343.
[Full Text]
