Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Case report
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1073 - 1075

Congenital-Left Atrial Appendage Aneurysm in an 8-Year-Old Girl

Jayashankar Marla, Nisha Jayashankar Marla, Gururaj Tantri, Chandrashekar Jayaprakash

1. Consultant Cardiothoracic Surgeon, AJHRC. 2. Associate Professor, FMMC. 3. Consultant Cardiac Anaesthesiologist, AJHRC. 4. Professor, FMMC.

Correspondence Address :
Dr. Nisha J Marla Associate Professor, Department of Pathology Father Muller Medical College Kankanady -575004, Mangalore, Karnataka, India. Phone: 9481148975 E-mail: nishajmarla@gmail.com

Abstract

Congenital aneurysm of the Left Atrial Appendage (LAA) is extremely rare because after the first case no was described by Diamond in 1960, only 50 cases have been reported in the literature. Congenital aneurysm of the LAA is rarely diagnosed during childhood. Generally it manifests during the second or third decades of life. We are reporting here a case of congenital left atrial appendage aneurysm in an 8 year old girl who presented with breathlessness on exertion which was present since 6 months. Pre-operatively, the diagnosis of aneurysm was made by chest radiography, echocardiography and magnetic resonance imaging. The surgical findings demonstrated a kidney shaped saccular aneurysm. The microscopic findings showed myocardial layers in variable numbers. Following an aneurysmectomy, the patient is now asymptomatic and in the sinus rhythm.

How to cite this article :

Jayashankar Marla, Nisha Jayashankar Marla, Gururaj Tantri, Chandrashekar Jayaprakash. CONGENITAL-LEFT ATRIAL APPENDAGE ANEURYSM IN AN 8-YEAR-OLD GIRL. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2018 Oct 18 ]; 6:1073-1075. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=August&volume=6&issue=6&page=1073-1075&id=2331

INTRODUCTION
Congenital aneurismal dilatation of the Left Atrial Appendage (LAA) is an uncommon cardiac anomaly. Despite the fact that aneurysm of the LAA is thought to be congenital in nature; most patients have few problems early in life. It is rarely diagnosed during childhood. Generally, it manifests during the second or third decades of life. The early age at presentation of our case and the rarity of the condition made us to present it. The origin of a congenital aneurysm is unknown; some authors have attributed it to dysplasia of the musculi pectinati. The patients who are affected by aneurysms of the LAA are at a risk of significant morbidity and mortality. Therefore, an early diagnosis and a prompt surgical excision are essential, in order to eliminate the risk of complications. Aneurysmectomy is curative, with an excellent prognosis (1),(2),(3).

Case Report

A 8-year old girl was referred to the Cardiothoracic Department with complaints of breathlessness on minimal exertion which was there since 6 months and a precordial bulge which was there since 1 year. The physical examination revealed no abnormalities other than the subtle pre-cordial bulge. A previous workup which was done by a paediatrician and a cardiologist revealed an aneurysm of the LAA. The Electrocardiogram (ECG) showed a normal sinus rhythm. Trans thoracic echocardiography demonstrated normal findings, except for an impressive dilatation of the LAA. Chest radiographs showed cardiomegaly with prominent convexity of the left basal aspect of the cardiac silhouette (Table/Fig 1a) and magnetic resonance imaging confirmed the left atrial appendage aneurysm (Table/Fig 1b) . The left atrial appendage was approached surgically through a median sternotomy and an under cardiopulmonary bypass. The pericardium was found to be intact. The surgical findings demonstrated a giant, kidney shaped, saccular aneurysm which was indenting the right ventricular out flow tract. The aneurysm was resected and it was closed with a continuous over and over suture in two layers. The gross specimen consisted of a sac like structure which measured 6×5×3cm. The external surface was pale white, with a glistening appearance (Table/Fig 2a). On cutting the cystic structure, the inner aspect revealed pectinati muscles (Table/Fig 2b). No thrombus was noted. The microscopic examination of the sac wall showed the myocardium with variable numbers of myocardial fibres (Table/Fig 3a). Masson trichrome staining showed mild fibrosis in the subepicardial layer (Table/Fig 3b). The post-operative course was uncomplicated, and now the patient is asymptomatic and in sinus rhythm.

Discussion

An isolated aneurysm of the left or right atrium is a rare congenital abnormality which was first described by Semans and Taussig in 1938. It represents a diagnostic dilemma in patients with cardiomegaly. An aneurysm of the LAA is extremely rare because after the first case was described by Diamond in 1960, only 50 cases have been reported in the literature (1),(2),(3).

The LAA is derived from the left primary atrium which forms during the fourth week of the embryonic development. It has developmental, ultra structural and physiological characteristics which are distinct from those of the left atrium proper. The LAA is a long, tubular, hook shaped structure which has a narrow junction with a venous component of the atrium proper. Both the left and right appendages are trabeculated, with muscle bars largely running parallel to each other, giving a comb like appearance and hence they are termed as the pectinati muscles (4),(5). Victor and Nayak postulated that the cause of the aneurysm may be congenital dysplasia of the pectinati muscles. An LAA aneurysm can occur in two forms, one being the intra pericardial type with an intact pericardium as was seen in the case which is under discussion and the other being the extra pericardial type which occurs in association with pericardial defects(3),(6). The congenital LAA aneurysm arises from a weak appendage aneurysm wall, with no other associated pathologies such as mitral valve disease, tuberculosis, syphilis, or pericardial defects, and it must fulfil the following criteria; presence of LA of normal characteristics, a direct continuity of blood flow between the LA and the appendage, the absence of pericardial defects, and the presence of the characteristics of a normal LAA in terms of the anatomical pathology (2),(6).

In a majority of the cases (75%), the main symptom which leads to its diagnosis is recurrent or continuous supraventricular arrhythmias. Adults with the LAA aneurysm may present with shortness of breath, palpitation due to atrial tachyarrhythmias, embolic complications like stroke and even chest pain which is accompanied by a rise in the levels of cardiac enzymes. In infants and children, the aneurysm may be the cause of a cardiac arrest, an atrial fibrillation, or a heart failure and sometimes it can present with a cardiac tamponade (1),(2),(3). The diagnosis of these aneurysms can be difficult. Physical examinations are non-contributory. In fact, the results of most of the cardiac examinations may be normal. ECGs may reveal arrhythmias in some patients. Chest radiographs always show a cardiac enlargement with a prominent convexity of the left upper border in the position of the left atrial appendage. The differential diagnosis which is made on the basis of the chest radiographs includes epicardial fat, a loculated effusion and a mediastinal mass. Transoesophageal Echocardiography (TOE) usually helps in the diagnosis of this condition. Intra operative TOE is a useful aid which helps in looking for a residual thrombus and in assessing the adequacy of the resection. In recent years, TOE and chest magnetic resonance imaging have proved to be useful in detecting and diagnosing this anomaly. A surgical treatment which is curative is usually recommended, even in asymptomaticCongenital aneurysmal dilatation of the left atrial appendage is rare, but it is a correctable lesion.

It represents a diagnostic dilemma in patients with cardiomegaly and it is commonly associated with supraventricular arrhythmias and life threatening systemic embolizations. The patients who are affected by aneurysms of the left atrial appendage are at a risk for significant morbidity and mortality, but with a prompt and low risk surgical resection, the prognosis is excellent (1),(2),(3),(6),(7).

References

1.
Fuente A, Urchaga A, Sanchez R, Fernandez JL, Moriones I. Congenital aneurysm of the left atrial appendage . AnnThor Surg. 2008; 85: 2139-40.
2.
Munarriz A, Escribano E, Urchaga A, Olaz F, Beunza M, Fuente A, Cantabrana S.
3.
Congenital aneurysm of the left arial appendage. European Journal of Echocardiography .2008;9:152-54.
4.
Hammad AM, Abdel-Aziz O, Alshiek RGH, Wahby EA. Idiopathic giant aneurysm of the left atrial appendage. IJTCVS .2004; 20:186-88.
5.
Al- Saady NM, Obel OA, Camm AJ. The left atrial appendage: structure, function and role in thromboembolism. Heart. 1999; 82:547-54.
6.
Victor S, Nayak VM. Aneurysm of the left atrial appendage. Tex Heart Inst J 2001; 28:111-18.
7.
Pome G, Pelenghi S, Grassi M, Vignati G, Pellegrini A. Congenital intra-pericardial aneurysm of the left atrial appendage. Ann Thor surg 2000; 69:1569-71.
8.
Sawalha W, Badaineh Y, Samara Y. A giant left atrial appendage aneurysm: A case report. JRMS. 2005; 12:41-44.
9.
Shaheen F, Gojwari T, Ahmad N. Congenital aneurysm of the left atrial appendage presenting as a young stroke: CT and MR findings. European Journal of Radiology Extra. 2008; 68:e107-e09.

DOI and Others

ID: JCDR/2012/4039:2331

Date of Submission: Jan 27, 2012
Date of Peer Review: Apr 09, 2012
Date of Acceptance: Jun 10, 2012
Date of Publishing: Aug 10, 2012

Financial OR OTHER COMPETING INTERESTS:
None.

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