E-page Original Images: Congenital giant aneurysm of the right atrium

A seven days old asymptomatic male neonate was referred to our center for evaluation of a heart murmur detected on routine physical examination. Vital signs were entirely normal. Cardiovascular examination revealed a normal first and second heart sound and a grade 2/6 systolic murmur at the left lower sternal border. The 12-lead electrocardiography showed regular sinus rhythm with normal right ventricular predominance. The P wave was normal. A chest radiography showed marked cardiomegaly with normal pulmonary vascularity (Fig. 1). A two-dimensional echocardiogram showed normal segmental anatomy. The right atrium was extremely dilated (Fig. 2), with an area of 14 cm2, for a left atrial area of 2.1 cm2. An atrial septal defect of 8 mm with left -to -right shunt was present. The tricuspid valve annulus measured 1.3 cm without stenosis, nor apical displacement. There was a trivial tricuspid incompetence with a pressure gradient of 25 mmHg. The rest of the echocardiography was normal. Angiography was done and revealed no additional information. There was slow flow inside the aneurysm with no evidence of thrombus. Treatment with aspirin as an antiplatelet agent was initialized.