Left Atrial Appendage Inversion Presenting as Acute Right Ventricular Failure after Left Ventricular Assist Device Implantation

Abstract

Graphical abstract

Intraoperative Inversion of the Left Atrial Appendage Following Ligation

“…Inverted LAAs will appear as a mass attached to the lateral or anterolateral wall of the LA in this region. 1 , 2 , 3 , 4 , 5 The midesophageal 2-chamber and mitral commissural views on TEE allow for sufficient investigation of the LAA. A midesophageal 4-chamber view and long-axis view can also be utilized to investigate left atrial masses.…”

“…For instance, multiple cases have been reported after left ventricular assist device implantation. 5 , 8 , 9 …”

“…In the context of CPB, this occurs when the cardiac volume is replenished. 2 , 3 , 5 In the absence of spontaneous resolution intraoperatively, interventions such as the Valsalva maneuver, manual eversion, or ligation have been used to resolve the inversion. 1 , 3 , 4 , 5 , 10 , 11 , 13 Ligation of the LAA has been performed to prevent recurrent inversion and thrombosis.…”

“… 2 , 3 , 5 In the absence of spontaneous resolution intraoperatively, interventions such as the Valsalva maneuver, manual eversion, or ligation have been used to resolve the inversion. 1 , 3 , 4 , 5 , 10 , 11 , 13 Ligation of the LAA has been performed to prevent recurrent inversion and thrombosis. 5 , 9 The intraoperative inversion after ligation in this case challenges the efficacy of ligation as a treatment.…”

“… 1 , 3 , 4 , 5 , 10 , 11 , 13 Ligation of the LAA has been performed to prevent recurrent inversion and thrombosis. 5 , 9 The intraoperative inversion after ligation in this case challenges the efficacy of ligation as a treatment. In the few cases in which LAA inversion persisted postoperatively, there was spontaneous resolution within 6 to 12 months.…”