Intussusception of Left Atrial Appendage through the Mitral Valve

Abstract

A 4-month-old male infant underwent elective repair of a large subaortic ventricular septal defect. Although it was an uneventful surgical procedure, he required inotropic support during weaning from cardiopulmonary bypass. He presented with sudden-onset low cardiac output syndrome in the immediate postoperative period and could not be revived. Autopsy revealed intussusception of the left atrial appendage projecting through the mitral valve orifice.

Intussusception of Left Atrial Appendage through the Mitral Valve

“…In Volume 7 issue Number 2 of the Asian Cardiovascular & Thoracic Annals , Dhaded and colleagues 1 reported the case of a 4-month-old child who died shortly after repair of a ventricular septal defect. Autopsy showed in-tussusception of the left atrial appendage, projecting into the mitral valve orifice, as the cause of death.…”

“…Intussusception of the left atrial appendage can complicate surgery for both congenital and acquired heart diseases. 2 Regarding the cause of intussusception of the left atrial appendage, Dhaded and colleagues 1 pointed out in their discussion that this can occur during inversion of the left auricular appendage in deairing maneuvers or because of left ventricular vent suction. Once a diagnosis of in-tussusception of the left atrial appendage is established during the postoperative period, either by echocardio-graphy (surface or transesophageal) or by magnetic resonance imaging, the limited number of reported cases does not allow for inferences on the relative risks of reoperation versus conservative treatment.…”