Left Atrial Dissection

Martinelli, Susan M.; Berry, John Richard Silveira; Dalal, Nishita; Stansfield, William E.; Moylan, Vincent; Kumar, Priya

doi:10.1213/ane.0000000000000449

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…After termination of CPB, gradual increase in LA pressure, exacerbated Although large and rapidly expanding dissections may cause left ventricular inflow obstruction and need immediate intervention, others may be hemodynamically stable and be managed conservatively. 8,11,12 The natural history of a dissection involves thrombus formation followed by resorption. 12 In the current patient, LA dissection progressed to rupture into the transverse sinus with concomitant decrease in severity of mitral regurgitation, which could be either due to underfilling of the left ventricle from volume loss or flow of blood into the periannular space.…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography

Niyogi

Kumar

Singh

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Left atrial mass after excision of a left atrial myxoma may occur due to residual or additional masses, such as biatrial or multicentric myxomas and inverted left atrial appendage. In this E-challenge, the authors present a case where intraoperative transesophageal echocardiography allowed visualization of a left atrial mass after excision of a left atrial myxoma. Detailed examination demonstrated that the mass was due to left atrial dissection that progressed to rupture, allowing its early detection and repair. A high index of suspicion, as well as coordination between the surgeon and the perioperative echocardiographer, played a crucial role in the detection and management of this complication.

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Section: Discussionmentioning

confidence: 99%

Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography

Niyogi

Kumar

Singh

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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Perioperative Management of Left Atrial Dissection After Mitral Valve Repair: Navigating the Challenges and Conundrums With a Rare Complication

Fernando

Zhou

Patel

et al. 2019

Journal of Cardiothoracic and Vascular Anesthesia

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3D imaging of left atrial dissection: a case report

Okano,

Kawashima,

Koshiba

et al. 2023

Gen Thorac Cardiovasc Surg Cases

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Background Left atrial dissection (LAD) is an uncommon but potentially devastating complication of cardiac surgery. Though surgical and conservative treatment strategies have been reported, the choice depends on each clinical situation. Especially in sensitive cases, the decision could be difficult, where the detailed assessment of the multiple imaging modalities is mandatory. Case presentation Open surgical total arch replacement (TAR) was performed on a male patient aged 79 years old, who had severe chronic obstructive pulmonary disease (COPD) and a history of aortofemoral bypass for abdominal aortic aneurysm and arteriosclerosis obliterans (ASO). During the weaning off the cardiopulmonary bypass (CPB), LAD was detected on intraoperative transesophageal echocardiography (TEE). It was 18 × 26 mm and full of hematoma with the TEE. Due to the patient’s frailty and not to elongate the CPB duration, we selected a conservative strategy. The patient was extubated on postoperative day (POD) 1 and transferred from ICU to the ward on POD 3. On POD 7, ECG-gated 3D-CT was performed, on which LAD occupied 26% of the left atrial volume. It also revealed the opening of the pulmonary veins and the proximity of the LAD and the coronary sinus (CS). The cause of the LAD was considered to be the CS perforation with a retrograde cardioplegic cannula. A follow-up 3D-TEE was performed on POD 15, where the hematoma inside the LAD was absorbed. He was discharged home at POD 23. With transthoracic echocardiography, LAD itself disappeared after 3 months. Conclusion 3D imaging, such as 3D-TEE and 3D-CT, is valuable in the assessment of the volume and quality of LAD. Furthermore, it clarifies the exact position and configuration of LAD, which help in assessing the etiology, predicting the hemodynamic disturbance, and determining the treatment strategy. They are potent tools, especially in complex cases.

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Left Atrial Dissection

Cited by 3 publications

References 8 publications

Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography

Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography

Perioperative Management of Left Atrial Dissection After Mitral Valve Repair: Navigating the Challenges and Conundrums With a Rare Complication

3D imaging of left atrial dissection: a case report

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