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 Table of Contents  
INTERESTING CASE REPORT
Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 217-219

A Rare Case of the Dilated Right Atrium in a Newborn


Department of Cardiology, Madurai Medical College and Government Rajaji Hospital, Madurai, Tamil Nadu, India

Date of Submission23-Dec-2019
Date of Decision26-Jan-2020
Date of Acceptance19-Feb-2020
Date of Web Publication19-Aug-2020

Correspondence Address:
Dr. S Balasubramanian
Department of Cardiology, Madurai Medical College and Government Rajaji Hospital, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiae.jiae_54_19

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  Abstract 

Aneurysms of the right atrium are extremely rare. These aneurysms can be associated with tachyarrhythmia, intracardiac thrombus formation, thromboembolism, and right ventricular compression precipitating heart failure. We report a case of a right atrial aneurysm in a newborn presenting with cardiac failure and multisystem dysfunction.

Keywords: Aneurysm, newborn, right atrium


How to cite this article:
Balasubramanian S. A Rare Case of the Dilated Right Atrium in a Newborn. J Indian Acad Echocardiogr Cardiovasc Imaging 2020;4:217-9

How to cite this URL:
Balasubramanian S. A Rare Case of the Dilated Right Atrium in a Newborn. J Indian Acad Echocardiogr Cardiovasc Imaging [serial online] 2020 [cited 2020 Oct 27];4:217-9. Available from: https://www.jiaecho.org/text.asp?2020/4/2/217/292635


  Introduction Top


Aneurysms of the right atrium are extremely rare. These aneurysms can be associated with tachyarrhythmia, intracardiac thrombus formation, thromboembolism, and right ventricular compression precipitating heart failure. We report a case of a right atrial aneurysm in a newborn presenting with cardiac failure and multisystem dysfunction.


  Clinical Presentation Top


A term newborn weighing 2.55 kg at birth was apparently normal till 15 days of age. Then, she developed poor feeding, vomiting, and lethargy and was taken to a private hospital for management. There, she developed cardiac arrest and revived and was on mechanical ventilation. She was referred to us for further management. She had shock, acute kidney injury (AKI) with elevated renal parameters, hyperkalemia, and an episode of seizures. Echocardiogram (ECHO) showed dilated right atrium without any other chamber enlargement or Epstein's anomaly [Figure 1], [Figure 2], [Figure 3]. Inter atrial septal aneurysm and a small atrial septal defect with left-to-right shunt were present. She was managed with mechanical ventilation, inotropes, and other antifailure measures. She had an episode of atrial tachycardia [Figure 4], reverted with DC cardioversion [Figure 5]. She improved well and was weaned from the ventilator; AKI resolved. Parents refused surgical resection at present.
Figure 1: Electrocardiogram of our case after reversion to sinus rhythm

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Figure 2: Four-chamber view showing dilated right atrium

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Figure 3: Parasternal long axis view showing dilated right atrium occupying major portion of the image

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Figure 4: Electrocardiogram of our case showing atrial tachycardia

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Figure 5: Continuous wave Doppler across tricuspid valve showing no significant tricuspid stenosis or tricuspid regurgitation

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  Discussion Top


Giant right atrial aneurysm is a rare condition of unknown origin; whether it is congenital or acquired is controversial.[1] Some prefer to call it idiopathic dilatation of the right atrium,[2] while others label it as congenital enlargement of the right atrium or right atrial diverticulum. In utero[3] and familial [4] cases have been reported. It can be diagnosed with antenatal or in the neonatal period or only in adulthood. It can be asymptomatic or present with cardiac failure due to severe tricuspid regurgitation or right ventricular compression, thromboembolism, or arrhythmias.

Secondary causes of right atrial dilatation have to be ruled out although sometimes it can be associated with any other cardiac defects.[5] It is obvious that there is a congenital structural defect in the atrial wall, which makes it prone to dilations even with modestly increased right-sided pressures. Lipomatous degeneration and reduction of muscular elements in the aneurysmal wall have been reported.[6]

The diagnosis can be established with ECHO, angiography, computed tomography (CT), or magnetic resonance imaging (MRI).[7] Transthoracic ECHO is the most commonly used technique. CT can provide good-quality anatomic information, and cardiac systolic function can be assessed, but not as precisely as with MRI.

Literature reports various ways to manage this condition, such as observational management, resection using cardiopulmonary bypass, and correction of associated defects. Conservative management may not prevent atrial dilatation, which may lead to complications of thromboembolism. Fatal arrhythmias, worsening tricuspid regurgitation, and sudden death can occur. Arrhythmias necessitate and have been successfully treated by surgical excision of the aneurysm.[2],[8],[9]

Relevance of this case in the neonatal intensive care unit: any neonate presenting with cardiac failure and dilated right atrium with intact IAS; this differential diagnosis has to be considered.


  Conclusion Top


Aneurysmal dilatation of the right atrium due to inherent defect in its wall can occur in the absence of other congenital defects or acquired heart disease. It usually presents with atrial, even ventricular arrhythmias, and heart failure. Treatment ranges from conservative to surgical resection, especially in the presence of arrhythmias.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Aryal MR, Hakim FA, Giri S, Ghimire S, Pandit A, Bhandari Y, et al. Right atrial appendage aneurysm: A systematic review. Echocardiography 2014;31:534-9.  Back to cited text no. 1
    
2.
Morrow AG, Behrendt DM. Congenital aneurysm (diverticulum) of the right atrium. Clinical manifestations and results of operative treatment. Circulation 1968;38:124-8.  Back to cited text no. 2
    
3.
da Silva AM, Witsemburg M, Elzenza N, Stewart P. Idiopathic dilatation of the right atrium diagnosed in utero. Rev Port Cardiol 1992;11:161-3.  Back to cited text no. 3
    
4.
Jenni R, Goebel N, Schneider L, Krayenbühl HP. Idiopathic familial right atrial dilatation. Schweiz Med Wochenschr 1981;111:1565-72.  Back to cited text no. 4
    
5.
Venugopalan P, Jain R. Accidental detection of a giant right atrial aneurysm in an asymptomatic infant. Acta Cardiol 2002;57:125-7.  Back to cited text no. 5
    
6.
Binder TM, Rosenhek R, Frank H, Gwechenberger M, Maurer G, Baumgartner H. Congenital malformations of the right atrium and the coronary sinus: An analysis based on 103 cases reported in the literature and two additional cases. Chest 2000;117:1740-8.  Back to cited text no. 6
    
7.
Chatrath R, Turek O, Quivers ES, Driscoll DJ, Edwards WD, Danielson GK. Asymptomatic giant right atrial aneurysm. Tex Heart Inst J 2001;28:301-3.  Back to cited text no. 7
    
8.
Masuda S, Saiki Y, Itoh K, Sadahiro M. Surgical treatment of congenital right atrial aneurysm in an adult patient. Jpn J Thorac Cardiovasc Surg 2004;52:254-6.  Back to cited text no. 8
    
9.
Scalia GM, Stafford WJ, Burstow DJ, Carruthers T, Tesar PJ. Successful treatment of incessant atrial flutter with excision of congenital giant right atrial aneurysm diagnosed by transesophageal echocardiography. Am Heart J 1995;129:834-5.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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