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An Unusual Congenital Heart Disease: Giant Left Atrial Appendage

Authors:

Julio C. Sauza-Sosa ,

Centro Hospitalario MAC Periferico Sur, Mexico City, MX
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Erika L. De la Cruz-Reyna,

Centro Hospitalario MAC Periferico Sur, Mexico City, MX
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Carlos N. Velazquez-Gutierrez

Centro Hospitalario MAC Periferico Sur, Mexico City, MX
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Abstract

A 52-year-old female was admitted to our hospital in April 2021 with dyspnea. She was discharged from the hospital 3 weeks ago due to the diagnosis of pneumonia caused by coronavirus disease 2019 (COVID-19). Physical examination revealed an oxygen desaturation of 82%. The patient underwent computed tomography angiography (CTA) that showed a ground-glass pattern and a giant left atrial appendage (Figure 1A). Film array respiratory panel was negative, and pulmonary aspergillosis was diagnosed after bronchoscopy. Cardiac magnetic resonance corroborated the huge left atrial appendage (Figure 1B). No other structural or functional heart abnormalities were diagnosed.

A giant left atrial appendage is a rare cardiac anomaly that can be congenital or acquired. In the literature, it is called a left atrial appendage aneurysm. The dilatation can be generalized or focused. Although it can occur in all age groups, it is predominant in patients in their 30s to 50s and most common in females.1 Patients can be asymptomatic or present with symptoms such as palpitations, chest pain, or dyspnea. A number of recent cases in the literature have highlighted the diagnostic utility of CTA.2 While there is no standard treatment for this condition, surgical resection is the most frequent therapy. Another option reported in the literature is anticoagulant treatment for select cases.3 Closure of the left atrial appendage is a more recent and emerging intervention that can be considered.

In our patient, we initiated anticoagulant therapy to reduce the risk of thromboembolic events; however, we recommended left atrial appendage occlusion or surgical resection after completing the treatment for pulmonary aspergillosis.

How to Cite: 1. Sauza-Sosa JC, De la Cruz-Reyna EL, Velazquez-Gutierrez CN. An Unusual Congenital Heart Disease: Giant Left Atrial Appendage. Methodist DeBakey Cardiovascular Journal. 2022;18(2):106-107. DOI: http://doi.org/10.14797/mdcvj.1059
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  Published on 14 Mar 2022
 Accepted on 15 Nov 2021            Submitted on 09 Nov 2021

Consent for Publication

The corresponding author had a written consent of the patient to use the data for publication.

(A) Computed tomography angiography showed a ground-glass opacity and a giant
Figure 1 

(A) Computed tomography angiography showed a ground-glass opacity and a giant left atrial appendage (red asterisk). (B) Cardiac magnetic resonance confirmed the huge left atrial appendage (red asterisk). Ao: aorta: PA: pulmonary artery; RA: right atrium; RV: right ventricle; LA: left atrium; LV: left ventricle.

Competing Interests

The authors have no competing interests to declare.

References

  1. Aryal MR, Hakim FA, Ghimire S, et al. Left atrial appendage aneurysm: a systematic review of 82 cases. Echocardiography. 2014 Nov;31(10):1312–8. doi: https://doi.org/10.1111/echo.12667 

  2. Harland DR, Suma V, Muthukumar L, Port SC, Werner PH, Tajik AJ. Giant Congenital Left Atrial Appendage Aneurysm Presenting With Recurrent Supraventricular Tachycardia and Chest Pain. CASE (Phila). 2019 Mar 4;3(3):129–132. doi: https://doi.org/10.1016/j.case.2019.01.003 

  3. Shah P. Surgically managed giant left atrial appendage clots. Acta Cardiol. 2020 Jun;75(3):254–255. doi: https://doi.org/10.1080/00015385.2019.1573293