Skip to main content
SpringerLink
Log in

Erstdiagnose eines Aneurysmas des linken Vorhofohres bei einer 69-jährigen Patientin

First Diagnosis of an Aneurysm of the Left Atrial Appendage in a 69-Year-Old Female Patient

  • KASUISTIK
  • Published:
Medizinische Klinik Aims and scope Submit manuscript

Zusammenfassung

Fallbeschreibung:

Berichtet wird über eine 69-jährige Patientin, die den Autoren zur Kardioversion bei persistierendem Vorhofflimmern zugewiesen wurde. Seit mehreren Wochen erfolgte eine therapeutische Antikoagulation. Im transösophagealen Echokardiogramm fand sich ein Aneurysma des linken Vorhofohres mit flottierendem Thrombus. Da die Patientin eine Resektion des Aneurysmas ablehnte, wurde trotz Fehlens der klassischen Risikofaktoren für eine Thromboembolie die Empfehlung zu einer dauerhaften Antikoagulation ausgesprochen.

Schlussfolgerung:

Aufgrund ihrer Seltenheit sind Patienten mit Vorhofohraneurysmata nicht in den Leitlinien zur Therapie des Vorhofflimmerns und zur Antikoagulation abgebildet. Wegen des hohen Risikos von Thromboembolien ist eine operative Resektion die Therapie der Wahl.

Abstract

Case Report:

A 69-year-old woman was admitted to hospital for cardioversion of persistent atrial fibrillation. She was on anticoagulation with a vitamin K antagonist for several weeks. Transesophageal echocardiography revealed a left atrial appendage aneurysm with a floating thrombus. None of the risk factors for thromboembolism mentioned in the guidelines for the management of patients with atrial fibrillation were present. As the patient refused surgical resection, long-term anticoagulation was recommended.

Conclusion:

Due to their scarcity, patients with left atrial appendage aneurysms are not considered in current management guidelines. Since this anomaly is associated with a potential risk of systemic embolization, surgical resection should be recommended even in asymptomatic patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Conradi G, Deetjen A, Möllmann S, et al. Symptomatic atrial fibrillation as the first symptom of a giant left atrial appendage aneurysm. Clin Res Cardiol 2006;95:614–616.

    Article  CAS  PubMed  Google Scholar 

  2. Dimond EG, Kittle CF, Voth DW. Extreme hypertrophy of the left atrial appendage. The case of the giant dog ear. Am J Cardiol 1960;5:122–125.

    Article  CAS  PubMed  Google Scholar 

  3. Frambach PJGM, Geskes GG, Wellens HJJ, et al. Giant intrapericardial aneurysm of the left atrial appendage. Eur Heart J 1990;11:848–853.

    CAS  PubMed  Google Scholar 

  4. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation — executive summary. J Am Coll Cardiol 2006;48:854–906.

    Article  PubMed  Google Scholar 

  5. Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA 2001;285:2864–2870.

    Article  CAS  PubMed  Google Scholar 

  6. Gold JP, Afifi HY, Ko W, et al. Congenital giant aneurysms of the left atrial appendage: diagnosis and management. J Card Surg 1996;11:147–150.

    Article  CAS  PubMed  Google Scholar 

  7. Kiaii B, Doll N, Kuehl M, et al. Minimal invasive endoscopic resection of a giant left atrial appendage aneurysm. Ann Thorac Surg 2004;77:1437–1438.

    Article  PubMed  Google Scholar 

  8. Omran H, Jung W, Rabahieh R, et al. Imaging of thrombi and assesment of left atrial appendage function: a prospective study comparing transthoracic and transoesophageal echocardiography. Heart 1999; 81:192–198.

    CAS  PubMed  Google Scholar 

  9. Ramaswamy P, Lytrivi ID, Srivastava S, et al. Left atrial appendage: variations in morphology and position causing pitfalls in pediatric echocardiographic diagnosis. J Am Soc Echocardiogr 2007;20: 1011–1016.

    Article  PubMed  Google Scholar 

  10. Ulucam M, Muderrisoglu H, Sezgin A. Giant left atrial appendage aneurysms: the third ventricle! Int J Cardiovasc Imaging 2005;21:225–230.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin III (Kardiologie), Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany

    Tomislav Miljak, Markus Kunze, Ralf Birkemeyer & Werner Jung

  2. Klinik für Innere Medizin III (Kardiologie), Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Vöhrenbacher Straße 23, 78050, Villingen-Schwenningen, Germany

    Tomislav Miljak

Authors
  1. Tomislav Miljak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Markus Kunze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ralf Birkemeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Werner Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomislav Miljak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miljak, T., Kunze, M., Birkemeyer, R. et al. Erstdiagnose eines Aneurysmas des linken Vorhofohres bei einer 69-jährigen Patientin. Med Klin 104, 875–877 (2009). https://doi.org/10.1007/s00063-009-1184-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00063-009-1184-6

Schlüsselwörter:

Key Words:

Search

Navigation