Giant Compressive Aneurysm of the Left Auricle in a 1-Day-Old Neonate
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 30×35-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.
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).
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).
The online-only Data Supplement, which contains 6 movies, can be found at http://circ.ahajournals.org/cgi/content/full/114/13/e511/DC1.