Rapidly vanishing left atrial dissection following mitral valve replacement: a case report

Abstract

Background: Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. nonsurgical) for left atrial dissection has not been fully established yet. Case presentation: Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the nonsurgical treatment of left atrial dissection. Conclusions: It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.

Intraoperative left atrial dissection following mitral valve surgery: Report of a case treated surgically

“…Such instability is mainly secondary to the expansion of the dissected cavity that may result in occlusion/obstruction of the atrial cavity, pulmonary vein orifice, or mitral valve inflow 4 . Conversely, surgical intervention may not be necessary with LatD without hemodynamic instability, as seen in previous reports 2,5 …”

“…4 Conversely, surgical intervention may not be necessary with LatD without hemodynamic instability, as seen in previous reports. 2,5 Surgeons have a variety of available surgical approaches to treat LatD. Most repairs focus on evacuation of the hematoma, obliteration of the dissected cavity, and closure of the entry injury.…”

Left atrial dissection : An unique complication of mitral valve surgery

“…Clinically, it varies from a self-limited complication to one which may have a devastating outcome due to hemodynamic instability(1). This instability is usually caused by signi cant paravalvular leak or obstruction of mitral valve in ow or pulmonary vein ori ce leading to low output syndrome which mandates surgical intervention (1,3).The presentation time varies between immediately intraoperatively to several years later (1,5). No established guidelines are currently published for the management of this rare entity (1,3,4).…”

“…However, the management varies between conservative for stable cases (26.6%) and surgical (73.4%) especially in unstable patients (1,3,4). The surgical principle is the elimination of the false lumen hematoma and closure of any identi able entry and re-entry points or plication/marsupialization if none can be de ned (3). The reported overall mortality rate and for surgical intervention is 12-14%, which compares favourably to LV rupture mortality of 75% (1,2).…”

“…It has been de ned as a false tract from mitral annulus to the left atrial free wall or interatrial septum (1) and can be associated with surgical and non-surgical cardiac etiologies (1). Despite being an rare entity (incidence 0.16-0.84%) (1,3,6), it may cause serious complications and mortality if it results in hemodynamic instability (1). We present an unusual case of a 72-year old woman who had a unique type of left atrial dissection during mitral surgery.…”