Dissection of the Atrial Septum Following Mitral Valve Surgery

Abstract

Interlayer dissection of the atrial septum resulting in the formation of a cavity developed after an attempted repair of a mitral paraprosthetic leak. Subsequent rupture of the cavity into both atria resulted in a small left-to-right shunt and significant left ventriculoatrial regurgitation. Misplaced stitches, aimed at obliterating the paraprosthetic leak, were the cause of the dissection. This case illustrates a previously unreported complication of mitral valve surgery and stresses the importance of proper exposure and handling of the mitral annulus.

Left Atrial Dissection after Left Ventricular Aneurysm Repair

“…LA dissection is an uncommon finding that occurs most often after mitral valve (MV) surgery, [1][2][3][4][5] though it has also been reported after aortic valve surgery, coronary artery bypass grafting, radiofrequency arrhythmia ablation, and pulmonary vein cannulation. [6][7][8][9][10] The differential diagnosis includes any obstructive pathology of the MV including thrombus, intracardiac tumor, coronary aneurysm, and pericardial effusion or cyst (though any of these should be evident on TEE examination prior to institution of CPB).…”

Left atrial dissection

“…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].…”