Discussion:
CLAA is a very rare entity in neonates with 70% of cases being left
atrial appendage aneurysms, and the remainder are left atrial aneurysms
(1). In neonates and infants, the early presentations of the lesion may
be attributed to the secondary MR, and airway obstruction which may
result in heart failure and respiratory distress syndrome (2,8). Even in
asymptomatic patients, surgery is mandatory due to the potential life
threatening complications, or the compression of the adjacent cardiac
and respiratory structures (2,5). According to previous reports, the
risk of complications increases as the size of CLAA increases (9).
Surgery is the treatment of choice and there are multiple surgical
approaches including median sternotomy with or without CPB, endoscopic
resection, left thoracotomy, and mini thoracotomy (4,6) The surgical
intervention through median sternotomy and with CPB is the preferred
one. This is because it enables the surgeon to perform the
aneurysmectomy and mitral valve repair if there is any distortion of the
valve (2).
To the best of our knowledge there are only four reported cases of
neonatal surgical management of congenital left atrial aneurysms (one
was LA aneurysm, and three were LA appendage aneurysms). Our case is
very unique for two reasons: the first, it represents the smallest age
at which CLAA was surgically managed, the second it is the largest LA
aneurysm ever presenting in a neonate. Moreover, it had a sessile
nature, and extended to the posterior wall of LV adjacent to marginal
arteries.