Giant Left Atrial Appendage Aneurysm in an Adolescent: Resection With Patent Foramen Ovale Closure

A 14-year-old female was incidentally found to have a giant left atrial appendage aneurysm (LAAA) and patent foramen ovale (PFO) on computed tomography, confirmed by transthoracic echocardiography. Given the inherent risk of arrhythmia and thromboembolic complications associated with LAAA, she underwent elective resection and PFO closure via median sternotomy with cardiopulmonary bypass. We discuss preoperative evaluation and surgical technique, emphasizing how aneurysm morphology, associated cardiac anomalies, and intraatrial thrombus influence choice of cardiopulmonary bypass, use of cardioplegic arrest, and surgical exposure. Based on a review of the literature, we propose a stepwise approach to guide operative planning for this rare condition.