Left Atrial Intramural Hematoma after Resection of Myxoma: Report of a Case

Abstract

A 73-year-old woman was referred for treatment of left atrial (LA) myxoma. At surgery, a myxoma was attached to the left atrial side of the fossa ovalis in the atrial septum by a stalk and was transmurally excised with a margin of the atrial septum. The atrial septum was closed without any prosthetic materials under mild to moderate tension. Although she was asymptomatic, postoperative transesophageal echocardiography (TEE) revealed an abnormal cavity, containing heterogeneous echogenesity without blood flow, in the posterior LA wall. Magnetic resonance imaging (MRI) demonstrated a mass without significant enhancement. It was considered to be an intramural hematoma, and the diagnosis of LA dissection was made. Follow-up echocardiography showed disappearance of the dissected lumen without surgical intervention. Both TEE and MRI are useful for the correct diagnosis of an LA dissection; and surgical intervention, entry closure or internal drainage, may not always be necessary in the absence of a hemodynamic compromise with an LA dissection.

Role of transesophageal echocardiography: A rare case of acute left atrial free wall dissection

“…Severe calcification of the mitral annulus may be contributory. [ 2 ] Besides from mitral procedures, aortic valve replacement[ 3 ] due to disruption of the noncoronary annulus in the region of aortic/mitral valve continuity, coronary artery bypass grafting,[ 4 ] left ventricular aneurysmectomy,[ 5 ] pulmonary vein cannulation,[ 6 ] and cardiac mass excision,[ 7 ] maze procedure have been associated with LAd. Partial atrioventricular (AV) separation and tissue fragility are the probable pathogenesis of LAd associated with mitral valve procedures,[ 4 ] although nonmitral cardiac surgeries quite remote from the AV junction can cause a LAd because of the creation of a small entry tear in the left atrial endocardium.…”

“…The mechanisms include: (1) Excessive traction on the sutures in the posterior annulus resulting in tearing through tissues and disruption,[ 7 ] (2) debridement of a very calcified valve, (3) oversizing of the prosthesis, and (4) inadequate reversal of anticoagulation may exacerbate the dissection. The close proximity of the circumflex artery and coronary sinus to the posterior wall of the left atrium, AV groove and mitral annulus is another important factor for the development of Lad during coronary artery bypass grafting surgeries.…”

Left atrial dissection

“…Other causes of LA dissection are trauma [1,58], tumor [70,71], and other conditions. Fujiishi reported a rare case of LA dissection that may have been due to paravalvular abscess-induced intramyocardial cavity formation in the LA wall after MVR [20].…”

Case of Left Atrium Intramural Hematoma After Percutaneous Coronary Intervention

“…Клинические проявления зависят от размеров ИГЛП, скорости ее развития, облитерации полости ЛП и сопутствующих нарушений гемодинамики. ИГЛП может протекать бессимптомно и выявляться случайно при плановом обследовании [1,24]. Наиболее частые симптомы заболевания -одышка, боль в груди, тахикардия.…”

“…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]…”