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Left atrial band: A rare congenital anomaly Kevin Liou, Manuja Premaratne, Gita Mathur Department of Cardiology, Eastern Heart Clinic, Prince of Wales Hospital, Randwick, Sydney, Australia
ABSTRACT
Received: 04‑03‑14 Accepted: 21‑04‑14
Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra‑operative transesophageal echocardiogram and characterize its appearance on two‑dimensional and three‑dimensional echocardiograms. Key words: Transesophageal echocardiography; Three‑dimensional echocardiogram; Left atrial band
INTRODUCTION Left atrial fibromuscular band is a rare congenital anomaly, which exists in a small proportion of the general population. Although its clinical significance remains largely unknown, it is generally considered a benign entity. We present a patient with an incidental finding of a left atrial band, which caused a great deal of anxiety among treating clinicians due to the unusual appearance on the patient’s intra‑operative transesophageal echocardiogram (TEE). CASE REPORT
Access this article online
Website: www.annals.in PMID: *** DOI: 10.4103/0971-9784.142077 Quick Response Code:
A 44‑year‑old male was referred to our institution for a coronary bypass surgery after he was diagnosed with significant double vessel disease following investigations for unstable angina. He was otherwise well with no documented co‑morbidities. His preoperative transthoracic echocardiogram was unremarkable. During the routine intra‑operative TEE, an abnormal linear structure was identified within the left atrium, which had the appearance of a pair of “tram track lines” [Figure 1]. It was thought this may have been a part of a catheter from the patient’s coronary angiogram performed 2 days earlier, although there were no documented complications associated with this patient’s previous
coronary catheterization, and he had remained well. Notwithstanding, given the unusual nature of this finding, the cardiologist was alerted and consulted for review. Cardiology assessment confirmed the presence of a linear band stretching across the left atrium in close proximity to the mitral annulus [Figure 1]. There was no associated mitral regurgitation or stenosis. Similarly, there was also no evidence of color flow across the inter‑atrial septum. In the absence of other reasonable explanations, the echo finding was considered consistent with a congenital left atrial band. However, as the patient was already on cardiopulmonary bypass, the operating surgeon elected to open the left atrium to explore this further.
Figure 1: Two-dimensional (upper) and three-dimensional (lower) transesophageal echocardiogram depiction of the left atrial band in mid esophageal long axis view
Address for correspondence: Dr. Kevin Liou, Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick 2031, Sydney, Australia. E‑mail: [email protected]
318
Annals of Cardiac Anaesthesia Vol. 17:4 Sep-Dec-2014
Liou, et al.: Congenital left atrial band
A 20 mm smooth band was identified in the left atrium with no other associated structural abnormalities. The band was subsequently excised. The surgery and patient’s postoperative recovery were uneventful. The histopathological examination of the excised surgical specimen confirmed the presence of fibromuscular tissues within the band, which is consistent with a congenital left atrial band.
patent foramen ovale and the Chiari network have been reported, while increased prevalence of premature atrial complex have also been observed.[1] Left atrial band has a characteristic appearance on echocardiogram as illustrated by this case, and it is our intention to raise clinicians’ awareness to this unique congenital anomaly by characterizing it on two‑dimensional and three‑dimensional echocardiograms.
DISCUSSION
REFERENCES
Congenital left atrial band is a rare finding and has an estimated prevalence of 2% based on an autopsy study.[1] It originates from the left atrial side of the fossa ovalis, and terminates in other areas within the left atrium.[1] At our institution, we have performed over 20,000 TEE in the last 20 years. This was the first case we have seen of this congenital abnormality. While the presence of a left atrial band appears to have no clinical significance in the majority of cases, mitral regurgitation due to tethering of the leaflet[2] as well as a possible link to cryptogenic stroke has been reported. [3] Further association between left atrial band and the presence of
1.
Annals of Cardiac Anaesthesia Vol. 17:4 Sep-Dec-2014
2.
3.
Yamashita T, Ohkawa S, Imai T, Ide H, Watanabe C, Ueda K. Prevalence and clinical significance of anomalous muscular band in the left atrium. Am J Cardiovasc Pathol 1993;4:286‑93. Baran T, Küçükoğlu MS, Okçün B, Cetin G, Hatemi AC, Uner S. A rare cause of mitral insufficiency: Left atrial anomalous band. Echocardiography 2003;20:83‑5. Ozer O, Sari I, Davutoglu V, Yigiter R, Akkoyun C. Cryptogenic stroke in two cases with left atrial band: Coincidence or cause? Eur J Echocardiogr 2009;10:360‑1.
Cite this article as: Liou K, Premaratne M, Mathur G. Left atrial band: A rare congenital anomaly. Ann Card Anaesth 2014;17:318-9. Source of Support: Nil, Conflict of Interest: None declared.
319
Copyright of Annals of Cardiac Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Left atrial band: A rare congenital anomaly Kevin Liou, Manuja Premaratne, Gita Mathur Department of Cardiology, Eastern Heart Clinic, Prince of Wales Hospital, Randwick, Sydney, Australia
ABSTRACT
Received: 04‑03‑14 Accepted: 21‑04‑14
Left atrial fibromuscular band is a rare congenital cardiac anomaly. We present a patient with an incidental finding of left atrial band on an intra‑operative transesophageal echocardiogram and characterize its appearance on two‑dimensional and three‑dimensional echocardiograms. Key words: Transesophageal echocardiography; Three‑dimensional echocardiogram; Left atrial band
INTRODUCTION Left atrial fibromuscular band is a rare congenital anomaly, which exists in a small proportion of the general population. Although its clinical significance remains largely unknown, it is generally considered a benign entity. We present a patient with an incidental finding of a left atrial band, which caused a great deal of anxiety among treating clinicians due to the unusual appearance on the patient’s intra‑operative transesophageal echocardiogram (TEE). CASE REPORT
Access this article online
Website: www.annals.in PMID: *** DOI: 10.4103/0971-9784.142077 Quick Response Code:
A 44‑year‑old male was referred to our institution for a coronary bypass surgery after he was diagnosed with significant double vessel disease following investigations for unstable angina. He was otherwise well with no documented co‑morbidities. His preoperative transthoracic echocardiogram was unremarkable. During the routine intra‑operative TEE, an abnormal linear structure was identified within the left atrium, which had the appearance of a pair of “tram track lines” [Figure 1]. It was thought this may have been a part of a catheter from the patient’s coronary angiogram performed 2 days earlier, although there were no documented complications associated with this patient’s previous
coronary catheterization, and he had remained well. Notwithstanding, given the unusual nature of this finding, the cardiologist was alerted and consulted for review. Cardiology assessment confirmed the presence of a linear band stretching across the left atrium in close proximity to the mitral annulus [Figure 1]. There was no associated mitral regurgitation or stenosis. Similarly, there was also no evidence of color flow across the inter‑atrial septum. In the absence of other reasonable explanations, the echo finding was considered consistent with a congenital left atrial band. However, as the patient was already on cardiopulmonary bypass, the operating surgeon elected to open the left atrium to explore this further.
Figure 1: Two-dimensional (upper) and three-dimensional (lower) transesophageal echocardiogram depiction of the left atrial band in mid esophageal long axis view
Address for correspondence: Dr. Kevin Liou, Eastern Heart Clinic, Prince of Wales Hospital, Barker Street, Randwick 2031, Sydney, Australia. E‑mail: [email protected]
318
Annals of Cardiac Anaesthesia Vol. 17:4 Sep-Dec-2014
Liou, et al.: Congenital left atrial band
A 20 mm smooth band was identified in the left atrium with no other associated structural abnormalities. The band was subsequently excised. The surgery and patient’s postoperative recovery were uneventful. The histopathological examination of the excised surgical specimen confirmed the presence of fibromuscular tissues within the band, which is consistent with a congenital left atrial band.
patent foramen ovale and the Chiari network have been reported, while increased prevalence of premature atrial complex have also been observed.[1] Left atrial band has a characteristic appearance on echocardiogram as illustrated by this case, and it is our intention to raise clinicians’ awareness to this unique congenital anomaly by characterizing it on two‑dimensional and three‑dimensional echocardiograms.
DISCUSSION
REFERENCES
Congenital left atrial band is a rare finding and has an estimated prevalence of 2% based on an autopsy study.[1] It originates from the left atrial side of the fossa ovalis, and terminates in other areas within the left atrium.[1] At our institution, we have performed over 20,000 TEE in the last 20 years. This was the first case we have seen of this congenital abnormality. While the presence of a left atrial band appears to have no clinical significance in the majority of cases, mitral regurgitation due to tethering of the leaflet[2] as well as a possible link to cryptogenic stroke has been reported. [3] Further association between left atrial band and the presence of
1.
Annals of Cardiac Anaesthesia Vol. 17:4 Sep-Dec-2014
2.
3.
Yamashita T, Ohkawa S, Imai T, Ide H, Watanabe C, Ueda K. Prevalence and clinical significance of anomalous muscular band in the left atrium. Am J Cardiovasc Pathol 1993;4:286‑93. Baran T, Küçükoğlu MS, Okçün B, Cetin G, Hatemi AC, Uner S. A rare cause of mitral insufficiency: Left atrial anomalous band. Echocardiography 2003;20:83‑5. Ozer O, Sari I, Davutoglu V, Yigiter R, Akkoyun C. Cryptogenic stroke in two cases with left atrial band: Coincidence or cause? Eur J Echocardiogr 2009;10:360‑1.
Cite this article as: Liou K, Premaratne M, Mathur G. Left atrial band: A rare congenital anomaly. Ann Card Anaesth 2014;17:318-9. Source of Support: Nil, Conflict of Interest: None declared.
319
Copyright of Annals of Cardiac Anaesthesia is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
