PMC5067771_01
Trans-thoracic echocardiographic 4-chamber and 5-chamber views showing an additional chamber within the left atrium just above posterolateral mitral annulus (arrows). Yellow arrow in right image points toward the communicating channel.
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Trans-thoracic echocardiogram showed a chamber within the LA just above the posterolateral mitral annulus communicating with the main LA cavity through a 12 mm hole with to-and-fro flow (Fig. 1).
Multiple trans-esophageal views showing the pseudo-aneurysm (A, green arrows), separate left atrial appendage (red arrow) and communication between the true left atrial chamber and the false chamber on color flow mapping (D).
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Trans-esophageal echocardiographic views confirmed these findings (Fig. 2, Fig. 3, video 1) and showed a flap of variable thickness originating from the left posterior atrio-ventricular junction and spreading upwards posteriorly and superiorly upto inter-atrial septum and a definite communicating orifice by color flow mapping. The LA was split into two vertical chambers by a flap in apical 4-chamber views starting from the lateral edge of the mitral annulus and reaching upto the left upper pulmonary vein (Fig. 4, video 2).
(Case #2): Multiple apical trans-thoracic echocardiographic views showing vertically split left atrium in 4-chamber views (X is the false chamber). In 5-chamber view, the false chamber or pseudo-aneurysm appears like a cystic mass (yellow solid arrows). (B, C) Communication between the two chambers situated above the posterior and lateral edge of the mitral annulus.
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The LA was split into two vertical chambers by a flap in apical 4-chamber views starting from the lateral edge of the mitral annulus and reaching upto the left upper pulmonary vein (Fig. 4, video 2).
Multiple 2D TEE views showing a cystic mass with some echogenic structure in the lower part (X) lateral to the left atrial appendage (C). (D) Two secundum atrial septal defects.
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Trans-esophageal echocardiography revealed a cystic mass adjacent to but separate from the LA appendage; with communication in the true LA just below the orifice of the left upper pulmonary vein and (Fig. 5, Fig. 6).