Left atrial dissection: A rare entity

Abstract

Left atrial wall dissection is uncommon. We present this rarity with transesophageal echocardiography in a 71‐year‐old female diagnosed with infective endocarditis three months following mitral valve repair, which along with the surgical intervention, may have contributed to the dissection.

Non‐iatrogenic left atrial wall dissection

“…6 Some authors state that the reversal of anticoagulation can prevent the progression of LAWD and can lead to spontaneous closure. 1,2,8,18,19 In conclusion, LAWD is a rare event, occurring predominantly after cardiac surgery, particularly after MV surgery. However, spontaneous manifestations can also be observed.…”

“…If LAWD causes compression of the LA and atrioventricular valve obstruction, symptoms of cardiac tamponade can also be observed. [1][2][3]8 Other authors have presented severe mitral regurgitation and compression of the circumflex artery as a manifestation of LAWD. 6 Diagnostic modalities for LAWD include TEE, CT, magnetic resonance imaging (MRI), and catheter study.…”

“…The pathogenesis of LAWD after MV surgery includes disruption of the tissue near the posterior anulus of the MV caused by excessive traction, trauma of the endocardium in the context of MV annulus decalcification, or LA thrombectomy, and rupture of the MV anulus resulting from prosthesis size mismatch. [1][2][3][7][8][9][10] Other reported pathogenesis of surgical iatrogenic LAWD includes injury during pulmonary vein cannulation and retrograde cardioplegic solution administration. 1,11 Other authors have documented LAWD caused by paravalvular abscess progression after MV surgery or LAWD concomitant with an endocarditis mass connected to the annuloplasty ring or endocarditis of the native valve.…”

“…1,11 Other authors have documented LAWD caused by paravalvular abscess progression after MV surgery or LAWD concomitant with an endocarditis mass connected to the annuloplasty ring or endocarditis of the native valve. 8,10,12 Nonsurgical iatrogenic pathogenesis of LAWD includes penetration of the distal vasculature during percutaneous intervention (PCI) and damage to the wall tissue by an ablation catheter or, more frequently, with a transseptal puncture. 3,[13][14][15] The most frequent patient-related risk factors include immunosuppressive and steroid medications.…”

“…1,2,10 The posterior valve leaflet and posterior wall of the LA are also common locations of LAWD caused by endocarditis, due to the small amount of fibrous tissue in these locations. 8,10 Localization of LAWD above the anterior mitral leaflet present with angina pectoris caused by pressure of the dissection sack on the circumflex artery. 6 Indications for surgical treatment of LAWD include clinical presentation and hemodynamic instability.…”