Key result
Conservative therapy with anticoagulation successfully treats a giant LAA aneurysm presenting with CHF and AF.
Why the study?
Left atrial appendage aneurysm is an exceptionally rare cardiac abnormality with limited evidence guiding management in asymptomatic individuals.
A rare case of a giant congenital left atrial appendage aneurysm presenting as congestive heart failure was successfully managed with conservative medical therapy and anticoagulation.
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May support conservative management with anticoagulation in giant LAA aneurysm with HF; hypothesis-generating and should not yet change practice.
Background Left atrial appendage aneurysm (LAAA) is an exceptionally rare cardiac abnormality that may be congenital or acquired. Although many patients remain asymptomatic for years, common presentations include palpitations, dyspnea, and thromboembolic events. Case Summary A 30-year-old woman with no previous medical history presented with two weeks of palpitations and exertional dyspnea. Examination revealed mild congestion and an irregular rhythm. Electrocardiography showed atrial fibrillation with a slightly rapid ventricular response. Chest radiography demonstrated a prominent left mediastinal border. Transthoracic echocardiography identified a large congenital LAAA adjacent to a normal-sized left ventricle with moderately reduced ejection fraction. She improved with intravenous diuretics, anticoagulation, and guideline-directed medical therapy. Given her preference for conservative therapy, she was discharged on rivaroxaban. She remained asymptomatic during follow-up. Discussion LAAA should be suspected in patients with unexplained left-sided mediastinal enlargement and atypical echocardiographic findings. Imaging is essential for diagnosis, and surgical aneurysmectomy is considered curative, although evidence guiding management in asymptomatic individuals is limited. Selected patients may be managed conservatively with close follow-up.
Dzebu et al. (2026) studied this question. Conservative medical management with anticoagulation successfully treated a rare giant left atrial appendage aneurysm presenting as congestive heart failure and atrial fibrillation.
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