Left Atrium Mass in an Infant with Complex Cyanotic Congenital Heart Disease

Abstract

The clinical and echocardiographic findings in a 3-month-old cyanotic infant with congestive cardiac failure are described with stress on segmental approach to diagnosis. Echocardiography reveals dextrocardia, situs inversus, d-loop ventricle, tricuspid atresia, transposition of great vessels, subpulmonic ventricular septal defect (VSD), d-malposed aorta, restrictive atrial septal defect (ASD), and large mass in high-pressure left atrium (LA). Systemic veins drain to left-sided morphological right atrium (RA) and pulmonary veins returned to the right-sided morphological LA. In the presence of tricuspid atresia, blood from the morphological LA has only one outlet into the morphological RA through a restrictive ASD resulting in a high-pressure left atrial chamber. Blood from the morphological RA drains into the left-sided morphological left ventricle. From the left ventricle through the subpulmonic VSD, a portion of blood is directed into the pulmonary artery (PA) by passing the hypoplastic morphological right ventricle (RV) as the PA overrides the VSD. Blood flows from the hypoplastic RV into the aorta. Besides, LA mass seen in this 3 month-old-baby in the given setting is an extremely rare finding and to my knowledge has not been reported in literature before.