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Bernabeu Santisteban R, Johannessen López MV, Carmona García P, Zarragoikoetxea Jauregui I, Argente Navarro P. An unusual intraoperative finding: left atrial dissecting intramural hematoma after aortic root replacement. JTCVS Tech 2022; 13:14-17. [PMID: 35711235 PMCID: PMC9196985 DOI: 10.1016/j.xjtc.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Rosa Bernabeu Santisteban
- Address for reprints: Rosa Bernabeu Santisteban, MD, Servicio Anestesiología y Reanimación, Hospital Universitari i Politècnic la Fe, Avda Fernando Martorell s/n, Valencia, Spain.
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2
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Seghatol-Eslami F, Farris GR, Chapman GD, Lloyd SG, Siegal GP. A Rare Cause of Left Atrial Mass. ACTA ACUST UNITED AC 2020; 4:260-262. [PMID: 32875192 PMCID: PMC7451912 DOI: 10.1016/j.case.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
LAIH may be a complication of blunt chest trauma. Multimodality imaging with TEE and CMR can lead to the correct diagnosis. Conservative management may be considered in hemodynamically stable patients.
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Affiliation(s)
- Frank Seghatol-Eslami
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gary Ross Farris
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregory D Chapman
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
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3
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Haseeb S, Kutyifa V. Left Atrial Intramural Hematoma After Radiofrequency Catheter Ablation: Beware of the Unexpected. JACC Case Rep 2020; 2:227-229. [PMID: 34317209 PMCID: PMC8298303 DOI: 10.1016/j.jaccas.2019.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sohaib Haseeb
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
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Cereda AF, De Luca F, Lanzone AM, Cottini M, Pastori L, Sangiorgi G. Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication? Catheter Cardiovasc Interv 2019; 95:E30-E36. [PMID: 31141311 DOI: 10.1002/ccd.28356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/17/2019] [Accepted: 05/16/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Left atrial dissection (LatD) is a rare and heterogeneous condition affecting many cardiovascular areas. The present article, by the means of personal case report illustration and systemic review of different clinical management, is aimed to give to clinicians further knowledge on this controversial topic. BACKGROUND LatD is an exceedingly rare but potentially fatal complication of cardiac surgery or catheter-based interventional procedures. Most of the cases are iatrogenic and its incidence is expected to grow due to an increase in the number of percutaneous coronary intervention and structural heart disease procedures. The management of this complication is controversial, and it may depend on related etiologies. METHODS We have reported our single-case experience and review of the scientific literature, focusing on the decision-making process and the strategical approach by multimodality imaging techniques. RESULTS Our case of LatD with initial hemodynamic instability was surgically treated. Conservative approach is often employed in literature despite the fact that conservative versus surgical approach is debatable, depending on clinical presentation, hemodynamic stability, multimodal imaging findings, and personal experience of the center. CONCLUSIONS According to systematic literature review, a watchful-waiting strategy supported by multimodality imaging could be a safe and effective management in stable LatD.
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Affiliation(s)
| | - Fabio De Luca
- Department of Cardiothoracic Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Alberto M Lanzone
- Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Marzia Cottini
- Department of Cardiac Surgery and Heart Transplantation, De Gasperis Center, Niguarda Hospital, Milan, Italy
| | - Luca Pastori
- Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Giuseppe Sangiorgi
- Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy.,Department of Systemic Medicine, Division of Cardiology, University of Rome Tor Vergata, Rome, Italy
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Fernando RJ, Zhou E, Patel PA, Garner C, Feinman JW, Ha B, Johnson SD, Weiss SJ, Goeddel LA, Augoustides JG. Perioperative Management of Left Atrial Dissection After Mitral Valve Repair: Navigating the Challenges and Conundrums With a Rare Complication. J Cardiothorac Vasc Anesth 2019; 33:2046-2052. [PMID: 30914215 DOI: 10.1053/j.jvca.2019.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| | - Elizabeth Zhou
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Chandrika Garner
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean D Johnson
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lee A Goeddel
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, John Hopkins University, Baltimore, MD
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Abstract
Right atrial dissection is a potentially life-threatening complication after ablation. Hemodynamic instability may occur and can be rapidly progressive. Agitated saline contrast echocardiography may help diagnose intracardiac dissection.
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Affiliation(s)
- Fatemat Hassan
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Akash Patel
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Vadiyala Mohan Reddy
- Division of Cardiothoracic Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Hythem Nawaytou
- Division of Cardiology, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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Moise OL, Loghin C, Tran SF, Estrera AL, Reece TB, Oxorn DC, Sheinbaum R. Left Atrium Dissection: A Rare Cardiac Surgery Complication. J Cardiothorac Vasc Anesth 2017; 31:1119-1122. [DOI: 10.1053/j.jvca.2016.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/11/2022]
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Kumar GA, Nandakumar NM, Sudhir BV, Pasarad AK. Role of transesophageal echocardiography: a rare case of acute left atrial free wall dissection. Ann Card Anaesth 2016; 18:593-5. [PMID: 26440252 PMCID: PMC4881675 DOI: 10.4103/0971-9784.166482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Transesophageal echocardiography (TEE) has been used routinely in the diagnosis and follow-up of cardiac cases. Left atrial dissection (LAd), an exceedingly rare complication of cardiac surgery, is most commonly associated with mitral valve surgery. A case of LAd is presented, and the pathology was accurately defined and immediately diagnosed using intraoperative TEE. This case highlights the importance of prompt diagnosis of LAd using intraoperative TEE, and a second cardiac surgery was avoided.
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Affiliation(s)
- G Anil Kumar
- Department of Cardiac Anaesthesiology, Sagar Hospital, Bengaluru, Karnataka, India
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Mohan JC, Shukla M, Mohan V, Sethi A. Spontaneous dissecting aneurysm of the left atrium complicated by cerebral embolism: A report of two cases with review of literature. Indian Heart J 2016; 68 Suppl 2:S140-S145. [PMID: 27751267 PMCID: PMC5067771 DOI: 10.1016/j.ihj.2015.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 12/22/2015] [Accepted: 12/24/2015] [Indexed: 11/28/2022] Open
Abstract
Left atrial dissection is a very uncommon complication of cardiac surgery and usually causes significant hemodynamic compromise. Little is known about spontaneous dissection of the left atrium. Two patients, one middle-aged man and another elderly woman were evaluated following stroke. Routine trans-thoracic echocardiogram showed vertical division of the left atrium with both chambers communicating with each other through an orifice. Detailed trans-oesophageal echocardiographic study revealed dissection of the left atrium producing an additional false chamber (pseudo-aneurysm) placed posterior to the left atrial appendage and above the postero-lateral aspect of mitral annulus. Spontaneous dissection of the left atrium is extremely rare, and there is no report of cerebral embolism associated with it. Review of literature reveals interesting facets of this rare entity.
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Affiliation(s)
- Jagdish C Mohan
- The Fortis Institute of Cardiac Sciences, Fortis Hospital, Shalimar Bagh, New Delhi 88, India.
| | - Madhu Shukla
- The Fortis Institute of Cardiac Sciences, Fortis Hospital, Shalimar Bagh, New Delhi 88, India
| | - Vishwas Mohan
- The Fortis Institute of Cardiac Sciences, Fortis Hospital, Shalimar Bagh, New Delhi 88, India
| | - Arvind Sethi
- The Fortis Institute of Cardiac Sciences, Fortis Hospital, Shalimar Bagh, New Delhi 88, India
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Santos Silva F, Barreiros CA, Antunes MC, O´Mendes M, Nobre ÂL. Unexpected Findings in the Left Atrium of a Patient With a Paravalvular Mitral Leak. J Cardiothorac Vasc Anesth 2015; 29:1737-9. [DOI: 10.1053/j.jvca.2015.07.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Indexed: 11/11/2022]
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Left atrial dissection. Gen Thorac Cardiovasc Surg 2015; 63:434-45. [DOI: 10.1007/s11748-015-0562-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/16/2015] [Indexed: 10/23/2022]
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Nabati M, Tabiban S, Ghaemian A, Bagheri B, Shokri M. Infective left atrial dissecting flap after cardiac surgery. J Cardiovasc Ultrasound 2014; 22:155-7. [PMID: 25309695 PMCID: PMC4192416 DOI: 10.4250/jcu.2014.22.3.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 05/18/2014] [Accepted: 08/20/2014] [Indexed: 11/25/2022] Open
Abstract
Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography.
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Affiliation(s)
- Maryam Nabati
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sasan Tabiban
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Ghaemian
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Babak Bagheri
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mojtaba Shokri
- Department of Cardiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Fukuhara S, Dimitrova KR, Geller CM, Hoffman DM, Tranbaugh RF. Left atrial dissection: an almost unknown entity. Interact Cardiovasc Thorac Surg 2014; 20:96-100. [DOI: 10.1093/icvts/ivu317] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Fukuhara S, Dimitrova KR, Geller CM, Hoffman DM, Ko W, Tranbaugh RF. Left atrial dissection: etiology and treatment. Ann Thorac Surg 2013; 95:1557-62. [PMID: 23453747 DOI: 10.1016/j.athoracsur.2012.12.041] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 12/17/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Left atrial dissection (LatD) is a rare entity most commonly associated with mitral valve surgery. We have reviewed our experience with 4 patients to better define the etiology and the treatment of LatD. METHODS From 1991 to 2012, 4 patients experienced LatD after surgery (1 of 6,302, or 0.02%, of isolated coronary artery bypass grafting patients and 3 of 1,895, or 0.16%, of mitral valve patients). Patient and perioperative data and management were reviewed. RESULTS Two patients were women, and ages ranged from 49 to 80 years. Three patients underwent mitral procedures (two replacements with coronary artery bypass grafting and one repair) for mitral regurgitation. One patient underwent emergent isolated coronary artery bypass grafting after cardiopulmonary resuscitation for a left main dissection during percutaneous coronary intervention. Three LatDs were found during surgery, and one LatD was found 12 days after mitral repair and was successfully treated nonoperatively. The LatD was located along the posterior atrial wall originating from the atrioventricular junction in all cases and obstructed mitral valve inflow. Operative repair focused on the evacuation of hematoma, obliteration of the false lumen, and repair of the entry injury. No mortality occurred. CONCLUSIONS Left atrial dissection is a rare complication of cardiac surgery, probably related to a contained atrioventricular separation allowing pressurized blood to separate the layers of the posterior left atrium. Prompt intraoperative diagnosis, obliterating the false cavity, and addressing the entry point are essential. In contrast, a nonoperative approach in a stable patient with a delayed LatD suggests healing of the dissection, and atrial remodeling occurs.
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Affiliation(s)
- Shinichi Fukuhara
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY 10003, USA.
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Pisklak PV, Tolpin DA, Youngblood SC, Collard CD, Pan W. Left Atrial Dissection after Left Ventricular Aneurysm Repair. Echocardiography 2012; 29:E163-5. [DOI: 10.1111/j.1540-8175.2012.01684.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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