Left atrial dissection: an almost unknown entity

Abstract

Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheter-based interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection.

Left ventricular basal inferior pseudoaneurysm and left atrial dissection after myocardial infarction: Case report

“…6 Left ventricular basal inferior pseudoaneurysm and its expansion through the mitral ring to left atria, causing left atrial free wall dissection, were assumed as mechanical complications of myocardial infarction. 6 Left ventricular basal inferior pseudoaneurysm and its expansion through the mitral ring to left atria, causing left atrial free wall dissection, were assumed as mechanical complications of myocardial infarction.…”

“…2 Other predisposing factors include percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), arrhythmia catheter ablation, and trauma. [1][2][3][4][5] Due to the rarity of this entity, incomplete understanding of its pathophysiology, and absence of guidelines to manage treatment, 6 the authors present a case of left atrial dissection after myocardial infarction. [1][2][3][4][5] Due to the rarity of this entity, incomplete understanding of its pathophysiology, and absence of guidelines to manage treatment, 6 the authors present a case of left atrial dissection after myocardial infarction.…”

Acute left atrial dissection during redo mitral valve replacement

“…In a previous extensive report on LA dissection, only four LA dissections were found after MVR and/or repair among 478 patients (0.84%) . Fukuhara et al reported that the incidence of LA dissection is 0.16% (3/1895) after mitral valve surgery and the overall mortality rate in the reported literature was 13.8% (12/87) …”

“…Operative intervention is always necessary if hemodynamic collapse exists. In previous reports, prompt surgical repair was undertaken for most patients (73.4%) . For successful surgical repair, it is mandatory to reestablish CPB first or insert an IABP to stabilize hemodynamics, reopen the LA to address the entry point, decompress the false lumen, and then gain an adequate evacuation of the hematoma …”

An abnormal chamber-like structure after mitral valve replacement

“…Symptoms vary from no symptom to rapid haemodynamic instability. Occlusion of the left atrium, pulmonary veins or mitral inflow, is the critical factor determining the necessity of surgical repair 4. The patient's symptoms were more related to the severe tricuspid regurgitation, but not to the left atrial dissection.…”