Giant Congenital Left Atrial Appendage Aneurysm Presenting With Recurrent Supraventricular Tachycardia and Chest Pain

Figure 1. Twelve-lead electrocardiogram revealing sinus bradycardia with poor R-wave progression and left atrial enlargement.

Figure 2. Computed tomographic images. (A) Axial computed tomography demonstrates a 7.0 × 6.9 × 5.9 cm giant aneurysmal left atrial appendage. (B) Computed tomographic 3D reconstruction of the LAAA. Ao, Aorta; LA, left atrium; LPV, left pulmonary vein; LV, left ventricle; RV, right ventricle; RVOT, right ventricular outflow tract.

Figure 3. Echocardiography and computed tomography. (A) TTE, apical four-chamber view. Arrowheads demonstrate aneurysmal portion of left atrial appendage. (B) TTE with contrast demonstrates absence of thrombus. (C) Three-dimensional computed tomographic reconstruction with apex oriented upward to correspond with transthoracic echocardiographic images. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 4. Three-dimensional TTE, apical four-chamber view. LA, Left atrium; LV, left ventricle.

Figure 5. Intraoperative transesophageal echocardiography: pulsed-wave Doppler flow at ostium of giant left atrial appendage. (1) Left atrial contraction resulting in flow entering LAAA. (2) Left atrial relaxation resulting in flow exiting LAAA. (3) Active emptying of the LAAA following the electrocardiographic P wave, resulting in a prominent flow (80 cm/sec) exiting the LAAA. (4) Late systolic filling of LAAA. (5) Early diastolic emptying of the LAAA.

Figure 6. Surgical specimen of giant LAAA immediately following excision.

Figure 7. Hematoxylin and Eosin–stained section of atrial appendage tissue. Atrial myocyte hypertrophy is seen.