862 convalescent phase of myocarditis—a CMR study. J Cardiovasc Magn Reson 2008;10: 19. 30. Nef HM, Mollmann H, Troidl C, Kostin S, Voss S, Hilpert P et al. Abnormalities in intracellular Ca2+ regulation contribute to the pathomechanism of Tako-Tsubo cardiomyopathy. Eur Heart J 2009;30:2155 –64. 31. Ellison GM, Torella D, Karakikes I, Purushothaman S, Curcio A, Gasparri C et al. Acute beta-adrenergic overload produces myocyte damage through calcium
K.A. Ahtarovski et al.
leakage from the ryanodine receptor 2 but spares cardiac stem cells. J Biol Chem 2007;282:11397 –409. 32. Mann DL, Kent RL, Parsons B, Cooper G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992;85:790 –804. 33. Christensen TE, Ahtarovski KA, Andersson H, Vejlstrup N, Ihlemann N, Kjaer A et al. Takotsubo-cardiomyopathy: a case of extremely fast recovery described by multimodality cardiac imaging. J Nucl Cardiol 2012;19:1240 –2.
IMAGE FOCUS
doi:10.1093/ehjci/jeu045 Online publish-ahead-of-print 28 March 2014
.............................................................................................................................................................................
Giant left atrial appendage aneurysm Sidi Ali Bouallouche1, Aoumria Bouziane1, Mojgan Laali2, Benjamin Safar1, and Olivier Milleron1* 1
Service de Cardiologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10 rue du Ge´ne´ral Leclerc 93370 Montfermeil, France and Service de Chirurgie Cardiaque, Groupe Hospitalier Pitie´ Salpeˆtrie`re, 47-83 Boulevard de L’Hoˆpital, 75013 Paris, France
2
* Corresponding author. Tel: +33 615958412; Fax: +33 140256732, Email: [email protected]
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 14, 2015
A 35-year-old black man without cardiovascular risk factor presented with dizziness. Physical examination found an irregular cardiac rhythm and ECG revealed atrial fibrillation with a slow ventricular response. Brain magnetic resonance imaging (MRI) showed small and recent vertebrobasilar ischaemic strokes. He was admitted in the cardiology department for transient ischaemic attack due to cardiac embolism. Transthoracic echocardiography (Panels A and B and see Supplementary data online, Video S1) revealed a large cavity (*) facing the left ventricular anterior wall. A large mass was, however, seen in the apical part of this cavity (arrow). Cardiac MRI showed that this cavity was a giant left atrial appendage aneurysm (11.2 × 4 cm) complicated with the presence of thrombi (Panel E and see Supplementary data online, Video S1). Three-dimensional transoesophageal echocardiogram (Panels C and D and see Supplementary data online, Video S1) was obtained and illustrated the spatial relationship of the aneurysm to the left atrium and left ventricle (see Supplementary data online, Videos S2 and S3). Aneurysm of the left atrial appendage is extremely rare and seems to be related to the congenital dysplasia of the pectinate muscles and of the left atrial muscle bundles related to them. Because of potential letal damages, surgical resection is the therapy of choice in all patients. After multidisciplinary heart team evaluation, this patient with a large aneurysm with thrombi complicated with ischaemic strokes underwent median sternotomy with left atrial appendage aneurysm resection (Panel E and see Supplementary data online, Videos S1). Histopathology examination found mild collagen fibrosis of the atrial wall. He was discharged home in sinus rhythm, and on a short course of anticoagulation.
K.A. Ahtarovski et al.
leakage from the ryanodine receptor 2 but spares cardiac stem cells. J Biol Chem 2007;282:11397 –409. 32. Mann DL, Kent RL, Parsons B, Cooper G. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992;85:790 –804. 33. Christensen TE, Ahtarovski KA, Andersson H, Vejlstrup N, Ihlemann N, Kjaer A et al. Takotsubo-cardiomyopathy: a case of extremely fast recovery described by multimodality cardiac imaging. J Nucl Cardiol 2012;19:1240 –2.
IMAGE FOCUS
doi:10.1093/ehjci/jeu045 Online publish-ahead-of-print 28 March 2014
.............................................................................................................................................................................
Giant left atrial appendage aneurysm Sidi Ali Bouallouche1, Aoumria Bouziane1, Mojgan Laali2, Benjamin Safar1, and Olivier Milleron1* 1
Service de Cardiologie, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10 rue du Ge´ne´ral Leclerc 93370 Montfermeil, France and Service de Chirurgie Cardiaque, Groupe Hospitalier Pitie´ Salpeˆtrie`re, 47-83 Boulevard de L’Hoˆpital, 75013 Paris, France
2
* Corresponding author. Tel: +33 615958412; Fax: +33 140256732, Email: [email protected]
Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 14, 2015
A 35-year-old black man without cardiovascular risk factor presented with dizziness. Physical examination found an irregular cardiac rhythm and ECG revealed atrial fibrillation with a slow ventricular response. Brain magnetic resonance imaging (MRI) showed small and recent vertebrobasilar ischaemic strokes. He was admitted in the cardiology department for transient ischaemic attack due to cardiac embolism. Transthoracic echocardiography (Panels A and B and see Supplementary data online, Video S1) revealed a large cavity (*) facing the left ventricular anterior wall. A large mass was, however, seen in the apical part of this cavity (arrow). Cardiac MRI showed that this cavity was a giant left atrial appendage aneurysm (11.2 × 4 cm) complicated with the presence of thrombi (Panel E and see Supplementary data online, Video S1). Three-dimensional transoesophageal echocardiogram (Panels C and D and see Supplementary data online, Video S1) was obtained and illustrated the spatial relationship of the aneurysm to the left atrium and left ventricle (see Supplementary data online, Videos S2 and S3). Aneurysm of the left atrial appendage is extremely rare and seems to be related to the congenital dysplasia of the pectinate muscles and of the left atrial muscle bundles related to them. Because of potential letal damages, surgical resection is the therapy of choice in all patients. After multidisciplinary heart team evaluation, this patient with a large aneurysm with thrombi complicated with ischaemic strokes underwent median sternotomy with left atrial appendage aneurysm resection (Panel E and see Supplementary data online, Videos S1). Histopathology examination found mild collagen fibrosis of the atrial wall. He was discharged home in sinus rhythm, and on a short course of anticoagulation.
