Unusual left atrial mass following cardiac surgery in an infant

Abstract

An unexpected left atrial mass was found during routine postoperative transthoracic echocardiogram in an infant following surgical closure of ventricular septal defect. Thrombus could not be excluded. At reoperation it was found to be an inverted left atrial appendage. This case demonstrates the echocardiographic appearance of an inverted left atrial appendage.

Inversion of the Left Atrial Appendage: A Complication of Cardiac Surgery

“…As this is a rare phenomenon, the natural history and incidence of subsequent complications are as yet undefined. Potential complications of an inverted LAA include: obstruction of the mitral valve, impaired ventricular filling leading to reduced cardiac and stroke indices [1], compromised appendage wall perfusion, mechanical damage to the appendage, and thrombus formation [2]. Of these, thrombotic events resulting from an inverted LAA are a particularly important consideration.…”

Unusual Left Atrial Mass: Inverted Left Atrial Appendage Caused by Massive Pericardial Effusion

“…Inverted LAA could present with cerebral emboli, as a mobile mass interfering ventricular filling, incarcerated left atrial appendage or be completely incidental in postoperative routine echocardiographic study 2,4 . In literature, there are cases where inverted LAA was diagnosed during the operation for suspected left atrial neoplasm or thrombus 2,5,6 . In a patient with left atrial mass in whom LAA could not be imaged, inverted LAA should come to mind, and more advanced imaging techniques such as TEE or CMRI should be used 3,7 …”

“…2,4 In literature, there are cases where inverted LAA was diagnosed during the operation for suspected left atrial neoplasm or thrombus. 2,5,6 In a patient with left atrial mass in whom LAA could not be imaged, inverted LAA should come to mind, and more advanced imaging techniques such as TEE or CMRI should be used. 3,7 Clinical data relating the significance and management of inverted LAA are not sufficient, and indication for surgical treatment or anticoagulation of an inverted LAA remains controversial.…”

Inverted left atrial appendage

“…[1][2][3] One possible cause of the complication may be negative pressure caused by the left ventricular vent inserted via the right superior pulmonary vein.2'3 Another possible cause is deairing, i. e., inverting the left atrial appendage on purpose. ' The key to diagnosis is previous heart surgery, preexisting conditions preventing thrombus formation (i.e., sinus rhythm and anticoagulant therapy) echocardiographic features, and knowledge that such an entity exists.…”