Spontaneous dissecting aneurysm of the left atrium complicated by cerebral embolism: A report of two cases with review of literature

Abstract

Left atrial dissection is a very uncommon complication of cardiac surgery and usually causes significant hemodynamic compromise. Little is known about spontaneous dissection of the left atrium. Two patients, one middle-aged man and another elderly woman were evaluated following stroke. Routine trans-thoracic echocardiogram showed vertical division of the left atrium with both chambers communicating with each other through an orifice. Detailed trans-oesophageal echocardiographic study revealed dissection of the left atrium producing an additional false chamber (pseudo-aneurysm) placed posterior to the left atrial appendage and above the postero-lateral aspect of mitral annulus. Spontaneous dissection of the left atrium is extremely rare, and there is no report of cerebral embolism associated with it. Review of literature reveals interesting facets of this rare entity.

A Rare Case of Mitral Prosthesis Dislocation Due to a Circumferential Left Atrial Dissection

“…LAtD is also reported after blunt trauma, cardiac amyloidosis, percutaneous procedures, myocardial infarction, radiofrequency ablation, and infective endocarditis ( 2 ). Spontaneous dissection of the LA has been rarely described ( 4 ).…”

Left atrial dissection: A rare entity

“…It also has more calcification and is less tough compared to the anterior leaflet. During surgical manipulation, the atrioventricular groove location also provides a vulnerable area for distension and dissection . It is hypothesized that debridement of calcified valves or inadvertent incision of the annulus during surgery may lead to dissection of the atrial wall creating the false chamber .…”

“…In circumstances when the false chamber causes obliteration of the left atrial cavity, obstruction to mitral valve inflow, pulmonary artery hypertension, right heart failure, and resultant hemodynamic compromise, immediate surgical intervention is required. In contrast, if there is no hemodynamic instability, it can often be medically managed conservatively with satisfactory outcomes . Prompt diagnosis, eliminating the false cavity, and addressing the entry point are essential in treatment .…”

“…In contrast, if there is no hemodynamic instability, it can often be medically managed conservatively with satisfactory outcomes. 4,6,8 Prompt diagnosis, eliminating the false cavity, and addressing the entry point are essential in treatment. 8 However, no definitive criteria exist to help guide management of this rarity.…”

An abnormal chamber-like structure after mitral valve replacement

“…The incidence rate is about 0.02%–0.16% in cardiac surgery patients 2. Recently, a less common spontaneous case has been published 3. Symptoms vary from no symptom to rapid haemodynamic instability.…”