Belov Dmitry Vladimirovich, Moskalev Vladimir Ivanovich, Garbuzenko Dmitry Victorovich, Arefyev Nikolay Olegovich
Department of Hospital Surgery, South Ural State Medical University, Chelyabinsk 454092, Russia.
Department of Hospital Surgery, Federal Center for Cardiovascular Surgery, Chelyabinsk 454033, Russia.
World J Clin Cases. 2020 Oct 6;8(19):4443-4449. doi: 10.12998/wjcc.v8.i19.4443.
An aneurysm of the left atrial appendage is one of the rare but potentially hazardous heart defects. The risk of lethal complications grows with its size. To date, about 150 cases of this defect have been described in the literature. We present a case of left atrial appendage aneurysm with the deformation of the mitral valve and the left main coronary and circumflex artery, which required mitral valve annuloplasty and bifurcation stenting.
A 58-year-old man presented to our hospital complaining of shortness of breath, general weakness, dizziness during physical exertion, and fatigue. Based on the results of echocardiography, an aneurysm of the left atrium was suspected. A free-breathing real-time cine magnetic resonance imaging with electrocardiograph synchronization confirmed the diagnosis of left atrial appendage aneurysm. The patient underwent an aneurysmectomy a median sternotomy with cardiopulmonary bypass. Intraoperative transesophageal echocardiography revealed relative mitral insufficiency that was corrected with an annuloplasty ring. Intraoperative coronary angiogram showed impaired blood flow in the left main coronary and circumflex artery and 60% stenosis. For this reason, bifurcation stenting was performed. The patient had an uneventful postoperative clinical course and was discharged from the hospital on the 10th day in a satisfactory condition.
Left atrial appendage aneurysm is a rare and dangerous heart pathology that requires surgery to prevent related complications.
左心耳动脉瘤是一种罕见但具有潜在危险性的心脏缺陷。其致命并发症的风险随瘤体大小增加而上升。迄今为止，文献中已描述了约150例该缺陷病例。我们报告一例伴有二尖瓣、左冠状动脉主干及回旋支变形的左心耳动脉瘤病例，该病例需要进行二尖瓣瓣环成形术和分叉处支架置入术。
一名58岁男性因劳力性呼吸困难、全身乏力、头晕及疲劳就诊于我院。基于超声心动图结果，怀疑为左心房动脉瘤。采用与心电图同步的自由呼吸实时电影磁共振成像确诊为左心耳动脉瘤。患者接受了动脉瘤切除术——在体外循环下进行正中胸骨切开术。术中经食管超声心动图显示存在相对性二尖瓣关闭不全，通过瓣环成形环予以纠正。术中冠状动脉造影显示左冠状动脉主干及回旋支血流受损且有60%的狭窄。因此，进行了分叉处支架置入术。患者术后临床过程平稳，于术后第10天情况良好出院。
左心耳动脉瘤是一种罕见且危险的心脏病变，需要手术以预防相关并发症。
