Repair of Spontaneous Left Atrial Dissection Resulting in Severe Paravalvular Native Mitral Valve Regurgitation

Abstract

A 54-year-old male with history of end-stage renal disease secondary to hypertension on hemodialysis with moderate aortic valve insufficiency presented with progressive exertional dyspnea and lower extremity edema over several weeks. Relevant history included hospitalization for Staphylococcus epidermidis bacteremia secondary to dialysis catheter line infection 6 months prior. ( Level of Difficulty: Advanced. )

Spontaneous left atrial dissection due to mitral regurgitation

“… 1 In patients with LA dissection secondary to infective endocarditis, unroofing of LA dissection is also useful to prevent a closed cavity from becoming infected. 5 Alongside MV repair in our patient, we simultaneously closed the LA dissection cavity to secure the entrance point of the flap with simple sutures between the mitral annulus and ring because the dissection flap and mitral annulus were not friable.…”

“…Spontaneous LA dissection without any preceding intracardiac manipulation is exceedingly rare and is generally attributed to underlying pathology involving severe mitral annular calcification and infectious endocarditis. 4 , 5 Infection and necrosis of a heavily calcified posterior mitral annulus are possible contributors to the formation of a dissection. 4 Nevertheless, our patient did not have such underlying causes and no history of cardiac procedures.…”

“…Different surgical techniques were reported, including entry closure with obliterating the false lumen and unroofing of the false lumen after removing the hematoma. 1 , 2 , 5 When the atrial wall tissue and mitral annulus are friable, concomitant use of strong surgical adhesive and a bovine pericardial or synthetic patch may be useful for entry closure by obliterating the false lumen. 1 In patients with LA dissection secondary to infective endocarditis, unroofing of LA dissection is also useful to prevent a closed cavity from becoming infected.…”