Delayed Left Atrial Wall Dissection After Mitral Valve Replacement

Abstract

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.

Left Atrial Dissection after Left Ventricular Aneurysm Repair

“…LA dissection is an uncommon finding that occurs most often after mitral valve (MV) surgery, [1][2][3][4][5] though it has also been reported after aortic valve surgery, coronary artery bypass grafting, radiofrequency arrhythmia ablation, and pulmonary vein cannulation. [6][7][8][9][10] The differential diagnosis includes any obstructive pathology of the MV including thrombus, intracardiac tumor, coronary aneurysm, and pericardial effusion or cyst (though any of these should be evident on TEE examination prior to institution of CPB).…”

Left atrial dissection

“…Four patients underwent aortic valve surgery including aortic valve replacement (AVR) with coronary artery bypass grafting (CABG) in 2 [34,35], AVR with minimally invasive technique in 1 [36], and AVR with both CABG and graft replacement of the ascending aorta in 1 [37]. 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].…”

“…Forty-seven patients had mitral valve surgery including MVR in 36 (76.6 %) (mechanical prosthesis: 28 [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20], bioprosthesis: 8 [1,2,5,[21][22][23][24][25], unknown: 1 [26]), mitral valve repair in 10 (21.3 %) [1,2,6,[27][28][29][30][31][32], and MVR after failure of repair in 1 (2.1 %) [33]. Of 37 patients who underwent MVR, 11 (29.7 %) had redo MVR [3, 5, 7-9, 11, 16, 18-20].…”

Atrial Dissection‐Like Appearance Caused by an Inferior Sinus Venosus Atrial Septal Defect with an Unroofed Defect

“…Left atrial dissection is defined as a gap from the mitral or tricuspid annular area into the interatrial septum. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis . Atrial dissection‐like appearance has been also reported; however, atrial dissection might be considered as an important differential diagnosis.…”