Idiopathic giant right atrial aneurysm
A 2-year-old boy was brought to the pediatrician in view of non-specific respiratory symptoms where mother thought that he had a brief episode of apnea during sleep. The child was otherwise completely asymptomatic. He was then referred for a chest X-ray [] that showed significant cardiomegaly and therefore an echocardiogram was obtained. This showed a giant right atrial aneurysm (7 × 6 cm) []. The tricuspid valve was anatomically normal with no stenosis or insufficiency. A small left-to-right shunt across a patent foramen ovale was also noted. Rest of the cardiac anatomy was normal. These findings were later confirmed by a cardiac magnetic resonance imaging (MRI) [Figures and ]. Slow-flow artifacts were seen within the lumen of the right atrium without intracavitary thrombus. To our surprise, the electrocardiogram was normal. It showed normal sinus rhythm with normal P wave morphology and no rhythm abnormalities.\nWe opted to proceed with surgical resection of the aneurysm after Discussions with the family, because of the risk of future thromboembolic complications and arrhythmias. Surgery was performed through median sternotomy. The pericardium was normal. A giant thin-walled aneurysm of the entire free wall of right atrium was noted []. After establishing cardiopulmonary bypass, the aneurysm was opened. There was no evidence of thrombus or inflammation within the right atrial aneurysm. The aneurysm was resected as two pieces measuring 2 × 2 cm and 7 × 3.5 cm respectively. After excision of the affected right atrial wall, the defect was closed and care was taken not to compromise the right coronary artery. Direct suture closure of the patent foramen ovale was also performed. Histopathological examination of the resected atrial tissue showed paper-thin walls [], and the pathological features included interstitial fibrosis and endocardial thickening with no evidence of thrombosis.\nThe postoperative course was significant for short non-sustained runs of ectopic atrial tachycardia that were controlled on Atenolol. He was discharged home 4 days after surgery. The chest X-ray [] performed following surgery showed significant reduction in cardiac size. An echocardiogram [] performed prior to discharge showed significant reduction in the right atrial size, trivial tricuspid regurgitation, and a small pericardial effusion. At the time of first post-operative visit to the clinic a week from discharge, the effusion had resolved and there were no new findings on the echocardiogram.