Left Atrial Dissection

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Echocardiography. 2007 Apr;24(4):443-4.
Left atrial dissection: an unusual complication of mitral valve surgery.
Jani S, Hecht S, Leibowitz K, Berger M.
Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA. sbjani@yahoo.com

Left atrial (LA) dissection is an uncommon complication of mitral valve surgery. We report a case of a patient found to have left atrial dissection two months after mitral valve repair. In brief, we also review etiology, presentation, and management of LAD.

Echocardiography. 2006 Aug;23(7):585-7.
Atrial dissection-like appearance caused by ileus due to metastatic renal cell carcinoma.
Dogan M, Ozeke O, Aras D, Deveci B, Yildiz A.
Department of Cardiology, Yuksek Ihtisas Hospital, Ankara, Turkey.

Atrial dissection is an uncommon entity, defined as a gap from the mitral or tricuspid annular area to the interatrial septum or atrial wall, creating a new chamber with or without communication into the true left or right atrium. We present the interesting images of an atrial dissection-like appearance in the right atrium, which was actually caused by an ileus due to metastatic renal cell carcinoma in a 82-year-old man. The causes of true atrial dissection were also briefly discussed.

Interact Cardiovasc Thorac Surg. 2005 Jun;4(3):173-4. Epub 2005 Mar 21.
Left atrial dissection following mass removal from right ventricle: non-surgical therapy.
Tasoglu I, Imren Y, Tavil Y, Zor H.
Gazi University Medical Faculty, Cardiovascular Surgery Department, Besevler 06500, Ankara, Turkey. tasoglu@gazi.edu.tr

Left atrial dissection is a severe but rare complication, and it is generally associated with mitral valve interventions. But other predisposing factors should be considered in pathogenesis. Here we describe a patient who developed interatrial dissection following a mass removal from right ventricle. The dissection was recognised with transesophageal echocardiography and it was spontaneously cured with conservative therapy. Transesophageal echocardiography is strongly recommended during and after operations in patients with heart valve interventions in order to recognise such rare but severe complications.

Cir Cir. 2004 Sep-Oct;72(5):421-5.
Left atrial dissection. Review
Rosas-Munive E, Valenzuela-Flores AG, Valenzuela-Flores AA.
Servicio de Gabinetes, Hospital de Cardiología, Centro Médico Nacional Siglo XXI, IMSS. emma_rosas@hotmail.com

The left atrial dissection is a rare complication occurring mainly after mitral surgery, thoracic trauma, myocardial infarction and infectious endocarditis. The clinical diagnosis can be confused with isolated prosthetic dysfunction, myocardial infarction. Its onset and, its form of presentation vary widely, concerning to the intensity and to the moment in which the symptoms appear. The most important data for its diagnostic are the antecedents and a new systolic murmur, although this last one can be absent. The transesophageal echocardiogram is the first choice for diagnosis since, the dissection can be missed by transthoracic echocardiogram. The treatment is surgical, two different types of surgical approaches have been reported. The prognosis depends on the extension of the dissection, tissue quality and associated complications.

Pacing Clin Electrophysiol. 2003 Aug;26(8):1771-3.
Endocardial flap of left atrial dissection following radiofrequency ablation.
Ramakrishna G, Cote AV, Chandrasekaran K, Malouf JF.
Division of Cardiovascular Diseases and Internal Medicine Department of Anesthesiology, Mayo Clinic Rochester, Rochester, Minnesota, USA.

This report describes an unusual mobile strand found by transesophageal echocardiography prior to a patient's second radiofrequency ablation for paroxysmal atrial fibrillation. This structure arose from the limbus of the left upper pulmonary vein, a location where radiofrequency energy bursts were delivered during the first ablation procedure. After seven months of therapeutic anticoagulation, there was no evidence of change in the size of the mass or of thromboembolism and the patient underwent radiofrequency ablation without complication. We believe this structure most likely represents an endocardial flap of left atrial dissection temporally related to radiofrequency ablation.

Ann Thorac Surg. 2003 Feb;75(2):584-6.
Left atrial dissection after double valve replacement.
Ninomiya M, Takamoto S, Kotsuka Y, Ohtsuka T.
Department of Cardiothoracic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan. mikio-ninomiya@par.odn.ne.jp

Left atrial dissection, a rare complication occurring mainly after mitral repair, is reported after double valve replacement in a patient with a connective tissue disease. A 63-year-old woman with systemic sclerosis underwent double valve replacement. Laceration of the tissue between the two mechanical prostheses and dissection of the left atrial wall emerged postoperatively and regurgitation through the dissection caused heart failure, which later improved without surgery. The possible causes of the dissection were thought to be shear forces against the tissue between the two prostheses and tissue fragility due to systemic sclerosis and corticosteroid therapy.

J Am Soc Echocardiogr. 2001 Aug;14(8):813-20.
Left atrial dissection: pathogenesis, clinical course, and transesophageal echocardiographic recognition.
Gallego P, Oliver JM, González A, Domínguez FJ, Sanchez-Recalde A, Mesa JM.
Departments of Cardiology and Cardiovascular Surgery, La Paz General Hospital, Autonoma University, Madrid, Spain. pastoragallego@teleline.es

Left atrial dissection is an uncommon entity. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis. We discuss a series of 11 patients with pathologically confirmed left atrial dissection who had been diagnosed previously by transesophageal echocardiography. Predisposing factors and surgical or pathologic findings were reviewed to identify the pathogenic mechanism and to explain the clinical course, hemodynamic disorder, and echocardiographic features. Dissection of the coronary sinus secondary to retrograde cardioplegia, endocarditis, cardiac rupture after myocardial infarction, and blunt chest trauma also could be related to its development. Transesophageal echocardiography identified a mobile intimal flap of the atrial wall that was creating a false chamber and allowed accurate diagnosis of prosthetic mitral valve function, endocarditis complications, and a left ventricular pseudoaneurysm after acute myocardial infarction. Color flow Doppler was particularly useful in identifying complications: communication between the false chamber and true left atria, permitting mitral regurgitation through the periannular route; development of atrial shunts; and severe tricuspid regurgitation caused by disruption of the anterior papillary muscle.

Eur J Echocardiogr. 2000 Jun;1(2):147-50.
Echocardiographic features of left atrial dissection.
Martinez-Sellés M, García-Fernandez MA, Moreno M, Bermejo J, Delcán JL.
Hospital Universitario Gregorio Marañon, Madrid, Spain.

AIMS: To study left atrial dissection, a rare complication of mitral valve replacement. METHODS AND RESULTS: From our hospital database of 5497 transoesophageal echocardiograms, we analysed 524 echocardiograms performed on 478 patients with mitral valve prosthesis. We found four patients (0.84%) with left atrial dissection diagnosed by transoesophageal echocardiography that visualized the left atrial dissection: in three patients the diagnosis was confirmed intraoperatively. Three patients had previously had replacements of the mitral valve. Left atrial dissection was a severe complication: one patient died and the two patients successfully operated on had paraprosthetic regurgitation. CONCLUSION: Transoesophageal echocardiography is the first choice for diagnosis of left atrial dissection, a rare complication of mitral valve replacement with an acute/subacute clinical course. Previous mitral valve replacement seems to be the main risk factor to develop left atrial dissection.

Echocardiography. 2000 Apr;17(3):259-61.
Delayed left atrial wall dissection after mitral valve replacement.
Idir M, Deville C, Roudaut R.
Hôpital Cardiologique du Haut-Lévêque, Avenue de Magellan, 33 604 Pessac, France.

We report two unusual cases of left atrial wall dissection creating a left atrial pseudoaneurysm associated with regurgitation a few months after mitral valve replacement. We emphasize the important role of transesophageal echocardiography in the diagnosis. The two patients successfully underwent surgery.

Ann Thorac Surg. 1999 Oct;68(4):1394-6.
Treatment of left atrial dissection after mitral repair: internal drainage.
Genoni M, Jenni R, Schmid ER, Vogt PR, Turina MI.
Clinic for Cardiac Surgery, University Hospital Zurich, Switzerland.

Two patients with intraoperative dissection of the entire left atrium after mitral valve repair are presented. Intraoperative transesophageal echocardiography detected left atrial dissection with formation of a large cavity compressing the left atrium. The false lumen was opened and widely connected to the right atrium to perform the decompression. This technique permits the runoff into the low pressure system in case of persisting hemorrhage from the unknown entry, and eliminates the risk of systemic embolization from the cavity.

Rev Esp Cardiol. 1998 May;51(5):402-3
Left atrial dissection and infective endocarditis.
Cordero Lorenzana ML, López Pérez JM, Merayo Macías E, Gulías López JM, Paz Rodríguez J.
Servicio de Medicina Intensiva, Hospital Juan Canalejo, La Coruña.

A rare case of left atrial dissection as a consequence of infectious endocarditis is reported. We present a patient with infectious endocarditis with involvement of mitral and aortic valves; in whom the trans-esophageal echocardiography was able to visualise the left atrial dissection. This complication has been reported after surgical repair of the mitral valve, but never in infectious endocarditis.

J Korean Soc Echocardiogr. 1997 Jul;5(1):70-73. Korean.
Left Atrial Dissection after Mitral Valve Replacement Demonstrated by Transesophageal Echocardiography.
Ji SB, Shin JH, Liang SJ, Yoon MH, Kim HS, Tank SJ, Choi BI.
Department of Cardiology, Ajou University, School of Medicine, Suwon, Korea.

Left atrial dissection is one of extremely rare complications associated with mitral valve surgery. We reported a case of left atrial dissection, which was developed after mechanical mitral valve replacement and was demonstrated by transesophargeal echocardiography. The cause of dissection was due to excessive traction of left atrial endocardial layer during surgery.

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