Totally Endoscopic Exclusion Of A Huge Left Atrial Appendage Aneurysm
Tomoki USHIJIMA, Hiromichi Sonoda, Takuya Nishijima, Meikun Kan-o, Satoshi Kimura, Akira Shiose.
Kyushu University Hospital, Fukuoka, Japan.
BACKGROUND: Left atrial appendage (LAA) aneurysm is a rare cardiac pathology. For most adult cases, the LAA aneurysm is asymptomatic and incidentally found. Its etiology is still unknown and the risk of rupture is unclear. However, a giant LAA aneurysm may have the potential risk of thromboembolism. We here report a successful case of totally endoscopic exclusion of a huge LAA aneurysm.
METHODS: A 23-year-old man had been in good health. A chest X-ray incidentally showed an abnormal cardiomegaly during a general medical checkup. Computed tomography revealed a huge LAA aneurysm with a maximum diameter of 8 cm. Our heart-team concluded to perform surgical intervention to prevent rupture and future thromboembolism.
Since the LAA aneurysm was greatly enlarged, off-pump clipping the LAA base with a clipping device or off-pump resection with a linear stapler was nearly impossible. Thereupon, we intraoperatively chose exclusion of the LAA under cardiac arrest in terms of safety and certainty. All procedures were conducted under thoracoscopic field of view via right mini-thoracotomy with a small skin incision of 5 cm. Cardiopulmonary bypass was established in a standard minimally invasive cardiac surgery manner, and after aortic clamping and induction of cardioplegic arrest, right-sided left atrium was opened. The LAA orifice was recognized and closed linearly with sutures. Subsequently, the base of the diminished LAA was resected using a linear stapler via the transverse sinus.
RESULTS: Operation was uneventfully completed, and postoperative computed tomography confirmed that the LAA was excluded completely.
CONCLUSIONS: We performed a totally endoscopic exclusion of a huge LAA aneurysm, which combined with suture closure of the LAA orifice via left atriotomy and subsequent resection of the LAA base using a linear stapler. This strategy is an effective optional approach for a huge LAA aneurysm to offer less invasiveness and operative safety and certainty simultaneously. 
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