Left Atrial Intramural Hematoma after Surgical Aortic Valve Replacement

Abstract

A 64-year-old gentleman with severe aortic stenosis was admitted for surgical aortic valve replacement. A bioprosthetic valve was implanted. Intraoperative transesophageal echocardiogram (TEE) immediately after cardiopulmonary bypass showed a well-seated bioprosthetic aortic valve with trivial intravalvular aortic insufficiency and no perivalvular leaks. The other cardiac valves showed normal function. Normal left ventricular (LV) and right ventricular (RV) systolic functions were noted, with no regional wall motion abnormalities.The patient came off bypass uneventfully, and the chest was closed. At this time, TEE demonstrated interval development of a mass in the posterolateral part of the left atrium, adjacent to the left atrial appendage and left upper pulmonary vein and extending to the coronary sinus ( Figure 1, see online videos 1-3). Consequently, the patient went back on cardiopulmonary bypass for further exploration, during which the surgical team discovered an intramural hematoma with no active hemorrhage. The hematoma was thought to be secondary to surgical trauma. TEE showed that valvular and ventricular function was unchanged.Reports of left atrial intramural hematomas as a complication of cardiac valve surgery are exceedingly rare. The patient exhibited stable hemodynamics, and a conservative approach was deemed appropriate with planned future reassessment by echocardiography. The patient had a benign perioperative course and was discharged home. He was doing well at 4-month follow up. Transthoracic echocardiography at that time showed resolution of the hematoma.Keywords: cardiopulmonary bypass, thoracic surgical procedure, intraoperative complications, left atrium, aortic valve stenosis, transesophageal echocardiography, transthoracic echocardiography, hematoma

Left Atrial Dissection During Minimally Invasive Mitral Valve Surgery

“…It is more often associated with MV surgery, and more so with replacement than repair. Cases have also been documented in coronary and aortic valve surgery, 3 , 4 excision of intracardiac masses, 5 and catheter-borne procedures such as ablation and percutaneous coronary intervention. 6 , 7 It can also occur spontaneously secondary to infiltrative or infective processes.…”

An unusual intraoperative finding: Left atrial dissecting intramural hematoma after aortic root replacement

“… 2 , 5 , 6 Many cases of benign course of LA intramural hematoma with conservative treatment have been reported. 3 , 7 …”

A Rare Cause of Left Atrial Mass

“…LA intramural hematoma (LAIH) is a rare entity. It has been reported as a complication of cardiac surgery 1 , 2 , 3 or interventional procedures such as catheter ablation of atrial fibrillation 4 , 5 , 6 and percutaneous coronary intervention. 7 , 8 , 9 LAIHs are rarely associated with interatrial septal dissection after transseptal puncture.…”