Congenital Left Atrial Appendage Aneurysm: Diagnosis and Management

Abstract

Aneurysm of the left atrial appendage is rare. We sought to review the published literature on left atrial appendage aneurysm (LAAA) to address its epidemiology, pathology, clinical symptoms, diagnosis and management. We reviewed PubMed from 1962 to 2016 to find relevant LAAA cases using medical subject heading (MESH) terms “atrial appendage” and “aneurysm” as search terms. Statistical analysis was done using Minitab 17.0. One hundred and one cases of LAAA were identified. The symptoms do not arise until the second to the fourth decades of life. Palpitation, dyspnea and chest pain were common clinical symptoms. Echocardiography is considered to be the primary method of diagnosis. Other imaging modalities such as cardiac computed tomography (CT) and magnetic resonance imaging (MRI) are useful for ruling out the differential diagnoses. Surgical treatment is often recommended even in asymptomatic patients for prevention the thromboembolic complications. Seventy-four patients (73.2%) reported in the literatures were treated by surgical treatment. The prognosis is favorable, for freedom from recurrent symptoms and arrhythmia has been reported from 10 days to 8 years follow-up. Echocardiography is considered the initial diagnostic tool for LAAA. The associated high risk of life-threatening complications and the relative ease of surgical removal suggest that prompt evaluation should be considered in patients with lesions adjacent to the left heart border.