Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement - case report

Bruegger, Dirk; Sadoni, Sebastian; Primaychenko, M; Sodian, Ralf; Schmitz, Christoph; Reichart, Bruno; Chappell, Daniel

doi:10.1186/1749-8090-6-50

Cited by 6 publications

(5 citation statements)

References 14 publications

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“…ЧП-ЭхоКГ позволяет уточнить диагноз у больных с плохим УЗ-окном, выполнить исследование во время операции. При ультразвуковой визуализации в полости ЛП выявляют образование дольчатой или кистозной структуры, связанное со стенкой ЛП [10,26]. Дифференциальный диагноз следует проводить с миксомой, эхинококкозом, тромбом ЛП, внешней компрессией ЛП за счет неопластических процессов или перикардиальных кист [7,10].…”

Section: Discussionunclassified

“…Была выбрана консервативная тактика ведения. Через 24 часа после операции на МК начата терапия гепарином в/в с дальнейшим переходом на варфарин [26]. Увеличения ИГЛП в размерах не наблюдалось, и через три месяца она полностью регрессировала.…”

Section: Discussionunclassified

“…Для лечения таких больных используются различные подходы. В ряде случаев выполняют оперативное лечение, в других -успешно наблюдают консервативно, проводя симптоматическую терапию [1,15,24,26]…”

Section: Introductionunclassified

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Case of Left Atrium Intramural Hematoma After Percutaneous Coronary Intervention

et al. 2020

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Интрамуральная гематома левого предсердия (ИГЛП)-редко встречающееся осложнение вмешательств на сердце. В статье рассматриваются механизмы формирования этой патологии. Представлен случай развития ИГЛП после проведения чрескожного коронарного вмешательства (ЧКВ). По окончании процедуры больной пожаловался на интенсивные боли в груди. При проведении ЭхоКГ выявлена ИГЛП, занимающая большую часть полости левого предсердия (ЛП). Несмотря на компрессию левой нижней легочной вены и симптомы острой сердечной недостаточности, была выбрана консервативная тактика ведения, проводилось успешное симптоматическое лечение. Учитывая недавнее ЧКВ, двойная дезагрегантная терапия не прерывалась. ИГЛП постепенно уменьшалась в размерах. Через пять недель от начала заболевания пациент был выписан из стационара, через девять месяцев наблюдался практически полный лизис ИГЛП. Раздел обсуждения посвящен вопросам диагностики, выбора лечебной тактики, целесообразности проведения хирургического лечения и отмены антитромботической терапии.

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Section: Discussionunclassified

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Case of Left Atrium Intramural Hematoma After Percutaneous Coronary Intervention

et al. 2020

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“…Forty-seven patients had mitral valve surgery including MVR in 36 (76.6 %) (mechanical prosthesis: 28 [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20], bioprosthesis: 8 [1,2,5,[21][22][23][24][25], unknown: 1 [26]), mitral valve repair in 10 (21.3 %) [1,2,6,[27][28][29][30][31][32], and MVR after failure of repair in 1 (2.1 %) [33]. Of 37 patients who underwent MVR, 11 (29.7 %) had redo MVR [3, 5, 7-9, 11, 16, 18-20].…”

Section: Procedures Performed Before Onset Of La Dissectionmentioning

confidence: 99%

Left atrial dissection

Tsukui

Iwasa

Yamazaki

2015

Gen Thorac Cardiovasc Surg

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Left atrial (LA) dissection is a rare complication and is defined as a gap from the mitral or tricuspid annular area to the interatrial septum or left atrial wall. Because of its low incidence, this entity is not fully understood. LA dissection is related to mitral valve surgery as well as coronary artery disease, arrhythmia, trauma, tumor, and spontaneous occurrence. Transesophageal echocardiography is the most useful diagnostic modality for LA dissection, but multimodality investigation supports accurate diagnosis. There are two treatment options for LA dissection: surgical repair and close observation. Surgical repair involves entry closure and internal drainage. The indication for surgery should be based on the clinical presentation.

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“…4 Most IMHs resolve spontaneously after 4 to 12 weeks of conservative management. [13][14][15] These injuries should therefore be followed up with serial echocardiography to ensure their complete regression.…”

Section: Structural Injuriesmentioning

confidence: 99%

Common Cause of Mortality in Trauma but Manageable Nonetheless

et al. 2015

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Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Eachempati and Salemi), who respond to the information, sharing their reasoning with the reader (regular type). A discussion by the authors follows.A n obese but otherwise healthy 53-year-old man was unloading a delivery van when he was struck from behind by a slow-moving garbage truck, pinning him between the 2 vehicles. The patient was lying supine on the ground when emergency medical services arrived. He was alert and oriented with a Glasgow Coma Scale score of 15. The patient was complaining of pain in his right upper extremity and numbness in his left foot. His initial vital signs were notable for a heart rate of 100 bpm; his blood pressure was 150/90 mm Hg; and his breathing was elevated at 22 breaths per minutes. The patient denied loss of consciousness and had no neck, back, or chest pain. Per emergency medical services, the patient's midchest appeared erythematous and his left lung field was coarse on auscultation, and he had a small abrasion on his left knee. The rest of his in-the-field examination was unremarkable. A cervical collar was placed, and the patient was placed on a back-board for transport. The patient's vital signs remained stable en route per the emergency medical services' report, although he became increasingly anxious and repeatedly removed both his cervical collar and a nonrebreather mask that had been placed empirically.On arrival in our trauma bay, the patient was found to be in shock: pulse rate, 129 bpm; blood pressure, 69/51 mm Hg; respiratory rate, 20 breaths per minute; and O 2 saturation, 80% on room air. He remained awake with a Glasgow Coma Scale score of 15 but now was complaining of difficulty breathing and of right-sided chest and back pain. His primary survey was notable for rhonchorous breath sounds bilaterally and right-sided chest wall crepitus; his abdomen was soft and had no peritoneal signs. The patient remained tachycardic, but his blood pressure improved to 127/113 mm Hg as 2 L crystalloid and 1 U red blood cells were given in bolus. His O 2 saturation improved to 96% on a nonrebreather mask providing O 2 at 15 L/min. His initial ECG demonstrated sinus tachycardia with questionable electric alternans in leads V 1 and V 5 (Figure 1). The patient's focused assessment with sonography for trauma (FAST) examination was unremarkable. A chest radiograph revealed extensive right subcutaneous emphysema, multiple right lateral rib fractures, a small rightsided apical pneumothorax, and bilateral patchy opacities consistent with pulmonary contusion or hemorrhage. His cardiomediastinal silhouette was normal (Figure 2A). A pelvic radiograph was negative for injury. A right chest tube was inserted with minimal serosanguinous output ( Figure 2B), and a Foley catheter was placed.Dr Eachempati: Care of traumatically injured patients demands the participation of various members of a large, interdisciplinary team and, depending on local practice, can involve surgeons, emergenc...

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Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement - case report

Cited by 6 publications

References 14 publications

Case of Left Atrium Intramural Hematoma After Percutaneous Coronary Intervention

Case of Left Atrium Intramural Hematoma After Percutaneous Coronary Intervention

Left atrial dissection

Common Cause of Mortality in Trauma but Manageable Nonetheless

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