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      Surgical repair of a giant congenital right atrial aneurysm: a case report

      case-report

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          Abstract

          Giant congenital right atrial aneurysms are rare defects of the heart. Though usually asymptomatic, they can be potentially life-threatening. Major risks include heart failure, supraventricular arrhythmias, rupture of the wall of the aneurysm. This defect is usually diagnosed incidentally. It is commonly found when transthoracic echocardiography or chest X-ray is performed. In some cases computed tomography or cardiac magnetic resonance imaging is needed to establish the diagnosis. Potential therapeutic options include surgery, catheter ablation and conservative follow-up. Currently preferred method for correcting this defect is surgical excision of the aneurysm, when surgical indications are met. In this article we describe a successful aneurysmectomy performed on a 16-month old female infant, who at the time of hospitalization presented with severe heart failure and symptoms of cardiac tamponade.

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          Congenital malformations of the right atrium and the coronary sinus: an analysis based on 103 cases reported in the literature and two additional cases.

          Congenital malformations of the right atrium (RA) and the coronary sinus (CS) are rare, and only sporadic cases have been reported. Little is known about the clinical relevance of this disorder. We report on two patients, one with a giant RA diverticulum, the other with a diverticulum of the CS, and review 103 cases of such malformations that have been reported previously. A MEDLINE search was performed to collect all cases of congenital malformations of the RA and the CS reported in the literature between 1955 and 1998. Cases were classified into the following categories: (1) congenital enlargement of the RA; (2) single diverticulum of the RA; (3) multiple diverticula of the RA; and (4) diverticulum of the CS. Clinical presentation and outcome of the different types of malformations were analyzed. The patients most frequently presenting with symptoms were those with diverticula of the CS (n = 28) followed by those with single diverticula of the RA (n = 13), multiple diverticula (n = 4), and congenital enlargements of the RA (n = 60). The percentages of symptomatic patients were 93, 84, 75, and 53%, respectively. Symptoms were frequently caused by arrhythmias. Supraventricular tachycardia (SVT) was found in 42 of the patients (40%) and was most common in patients with diverticula of the CS (24 of 28 patients) and multiple atrial diverticula (3 of 4 patients). Sudden cardiac death was reported more frequently in patients with diverticula of the CS (18%) compared to those with congenital enlargement of the RA (5%) or single or multiple diverticula of the RA (6%). All seven patients with diverticula of the CS who were not treated with catheter or surgical ablation eventually died. Congenital malformations of the RA and the CS frequently are associated with arrhythmias. SVT and sudden cardiac death have been reported in a significant percentage of patients with diverticula of the CS.
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            Surgery of The Heart

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              Asymptomatic giant right atrial aneurysm.

              A 5-year-old asymptomatic boy was found incidentally, on a chest radiograph, to have gross cardiomegaly; further evaluation by echocardiography showed a giant right atrial aneurysm. The patient underwent successful surgical reduction of the right atrium, closure of an atrial septal defect, and tricuspid valve repair These measures were taken to prevent thrombus formation in the right atrium, prevent paradoxical embolism, and lower the risk of atrial arrhythmias. The morphologic features of the resected atrial tissue showed paper-thin wall with a central aneurysm and focal endocardial fibrosis consistent with a diagnosis of idiopathic dilatation of the right atrium.
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                Author and article information

                Contributors
                karolismd@gmail.com
                arturas.lipnevicius@santa.lt
                rita.sudikiene@santa.lt
                edvardas.zurauskas@vpc.lt
                virgilijus.lebetkevicius@santa.lt
                virgilijus.tarutis@santa.lt
                Journal
                J Cardiothorac Surg
                J Cardiothorac Surg
                Journal of Cardiothoracic Surgery
                BioMed Central (London )
                1749-8090
                14 May 2015
                14 May 2015
                2015
                : 10
                : 72
                Affiliations
                [ ]Faculty of Medicine Centre of Cardiac Surgery, Vilnius University, Santariskiu g. 2, Vilnius, 08661 Lithuania
                [ ]Department of Cardiovascular Medicine, Vilnius University, Vilnius, Lithuania
                [ ]Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
                Article
                277
                10.1186/s13019-015-0277-y
                4433065
                25971888
                bdd605e9-aeb6-4e8e-b716-8f9d247fee48
                © Jonavicius et al.; licensee BioMed Central. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 23 October 2014
                : 1 May 2015
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2015

                Surgery
                congenital right atrial aneurysm,atrial dilatation,heart defects
                Surgery
                congenital right atrial aneurysm, atrial dilatation, heart defects

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