Giant Left Atrial Appendage Aneurysm
A 31-year-old woman presented with lightheadedness, dizziness, and intermittent palpitations. On physical examination, she was tachycardic with an irregular rhythm. An ECG confirmed atrial fibrillation/flutter. The chest x-ray (Figure A) was notable for an abnormal upper left heart border. A transthoracic echocardiogram revealed a left atrial appendage aneurysm (Figure B and C). The giant left atrial appendage aneurysm was further delineated by a transesophageal echocardiogram (Figure D), which demonstrated sluggish systolic and diastolic flow throughout the cavity. The aneurysm measured 7.2×3.9 cm on cardiac magnetic resonance imaging (Figure E). Before surgery, computed tomography 3-dimensional reconstruction (Figure F) was obtained and illustrated the spatial relationship of the aneurysm to the left atrium and left ventricle. The classic appearance of left ventricular anterolateral wall compression by the aneurysm was well demonstrated. The patient underwent median sternotomy with left atrial appendage aneurysm resection and left-sided Maze procedure. She was discharged home with resolution of symptoms, in sinus rhythm, and on a short course of anticoagulation.