Ann Thorac Surg 2005;80:2382
© 2005 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Neonatal Right Atrial Aneurysm
Christopher E. Mascio, MD
a
,
Harold M. Burkhart, MD
a
,
*
,
Thomas Fagan, MD
b
,
Shuping Ge, MD
b
,
Douglas M. Behrendt, MD
a
a Division of Cardiothoracic Surgery, Iowa City, Iowa USA
b Division of Pediatric Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
* Address correspondence to Dr Burkhart, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, 1603 JCP, Iowa City, IA52242-1086; (Email: harold-burkhart{at}uiowa.edu).
Our service was consulted for evaluation of a right atrial mass in a 1-week-old female infant discovered on a routine prenatal ultrasound. The patient was a 3 kg female born at 38 weeks. The pregnancy was notable only for the discovery of a cystic mass that appeared to be originating from the right atrium. The patient was asymptomatic. A postnatal echocardiogram confirmed the presence of a 1.6 cm x 2.2 cm chamber connected to the right atrium through a 1.5 cm opening in the lateral wall of the atrium (Fig 1; arrow shows patent foramen ovale; AA = atrial aneurysm; LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle). The patient was also noted to have a 3-mm patent foramen ovale. Her electrocardiogram demonstrated normal sinus rhythm. To better delineate the anatomy of this chamber, the patient underwent right heart catheterization that revealed a right atrial aneurysm (Fig 2; AA = atrial aneurysm; RA = right atrium; RV = right ventricle; SVC = superior vena cava). Right atrial aneurysm is a rare cardiac anomaly that has been previously described in both symptomatic and asymptomatic patients [1–3]. Because of the concern for potential arrhythmias and thromboembolic complications, we recommended operative resection of the aneurysm. At the time of operation, the right atrial aneurysm was noted to be bulging laterally into the right lung (Fig 3; AA = atrial aneurysm; RAA = right atrial appendage; RV = right ventricle). There was no neck to the aneurysm, so cardiopulmonary bypass was instituted with bi-caval cannulation. The atrium was opened through the aneurysm and the patent foramen ovale was closed. The aneurysm was resected, and the lateral wall of the right atrium was repaired in two layers. Postoperative echocardiography revealed normal right atrial size and a normally functioning tricuspid valve. Pathologic examination of the resected tissue revealed variable absence of myocardium with foci of recent fibrin thrombi attached to the endothelium. The patient's postoperative course was uneventful. She was discharged home on postoperative day 3.
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References
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- Chatrath R, Turek O, Quivers ES, Driscoll DJ, Edwards WD, Danielson GK. Asymptomatic giant right atrial aneurysm Tex Heart Inst J 2001;28(4):301-303.[Medline]
- Suedkamp M, Horst M, Melhorn U, Hoppe U, Arnold G, deVivie ER. Surgical repair of right-atrial aneurysm Thorac Cardiovasc Surg 2000;48(1):35-37.[Medline]
- Zeebregts CJ, Hensens AG, Laquet LK. Asymptomatic right atrial aneurysmfortuitous finding and resection. Eur J Cardiothorac Surg 1997;11(3):591-593.[Abstract]
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