Transesophageal Echocardiogram Diagnosis of Postoperative Left Atrial Pseudoaneurysm with Spontaneous Healing

Abstract

A case of asymptomatic left atrial wall rupture with pseudoaneurysm formation following coronary artery-bypass grafting (CABG) is illustrated. The patient was a 69-year-old man, who underwent a CABG in June 1994. During a routine postoperative transthoracic echocardiogram, a left atrium-adjacent cavity filled with high velocity fluid was seen. A pseudoaneurysm formation was suspected. Diagnosis was supported by transesophageal echocardiography and confirmed by cardiac MRI examination. The patient was not reoperated on for repair because of lack of symptoms and normal hernodynamic conditions. Transesophageal echocardiography was repeated forty days and eight months after CABG and revealed spontaneous disappearance of the left atrial pseudoaneurysm. At present (March 1996) the patient is as well as can be expected after CAJ3G and enjoys a good quality of life. Figure 1. Transthoracic echocardiogram. Apical four-chamber view. (A) A cavity adjacent to left atrium is seen (*). I n this early systolic frame, the left atrial wall is moderately collapsing. (B) Routine Color Doppler interrogation of mitral valve reveals flow signal within the cavity (arrow) and a mild mitral regurgitation. I n all figures, unless otherwise stated, flow signals mouing toward the transducer are shown in red, while those moving away are displayed in blue. DA = discending aorta; LA = left atrium; LV = left ventricle; M R = mitral regurgitation; RA = right atrium; RV = right ventricle.

Left atrial dissection

“…The size of the LA dissection in 27 patients was reported to range between 11 and 120 mm. An intimal tear in the LA was found in 19 patients [3,5,8,10,11,14,16,20,29,33,38,45,49,51,55,57].…”

“…Three patients had both mitral and aortic valve surgery [1,12,14]. Of 16 patients with CAD, 7 patients (43.8 %) had PCI [38][39][40][41][42][43], 5 (31.3 %) had CABG [2,[44][45][46][47], and 4 had no procedure [1,[48][49][50]. PCI was performed to the left circumflex artery in 4 patients and to …”