Successful surgical repair of left atrial dissection after mitral valve replacement

Rapidly vanishing left atrial dissection following mitral valve replacement: a case report

“…A pressurized blood flow from the left ventricle across the annulus in the opposite direction of the pericardial cavity could form the dissection cavity, because of the separation of the layers of the left atrium; therefore, LAD may be classified as a subtype of type I left ventricular rupture. Extensive debridement of the posterior annulus or subvalvular apparatus (especially in the heavily calcified areas of the annulus), inappropriate suturing of or traction applied on the annulus, oversizing of the inserted prosthesis, inadvertent injury to the endocardium of the left atrium by surgical retraction, and inadequate reversal of anticoagulation may contribute to the occurrence of LAD after mitral valve surgery [4]. Furthermore, LAD is most frequently located in the posterior wall of the left atrium as reported by Fukuhara et al [5].…”

Acute left atrial dissection during redo mitral valve replacement

“…In previous reports, prompt surgical repair was undertaken for most patients (73.4%) . For successful surgical repair, it is mandatory to reestablish CPB first or insert an IABP to stabilize hemodynamics, reopen the LA to address the entry point, decompress the false lumen, and then gain an adequate evacuation of the hematoma …”

“…2 For successful surgical repair, it is mandatory to reestablish CPB first or insert an IABP to stabilize hemodynamics, reopen the LA to address the entry point, decompress the false lumen, and then gain an adequate evacuation of the hematoma. [3][4][5] In this case, the causes of dissection may have been the operative shear forces of the prostheses against the tissue of the mitral annulus, as well as the mechanical shear forces caused by using a retractor on the LA myocardium. Tissue fragility due to the redo operation and severe adhesion was also one of the related factors in this case.…”

Left atrial dissection

“…The size of the LA dissection in 27 patients was reported to range between 11 and 120 mm. An intimal tear in the LA was found in 19 patients [3,5,8,10,11,14,16,20,29,33,38,45,49,51,55,57].…”

“…Forty-seven patients had mitral valve surgery including MVR in 36 (76.6 %) (mechanical prosthesis: 28 [1][2][3][7][8][9][10][11][12][13][14][15][16][17][18][19][20], bioprosthesis: 8 [1,2,5,[21][22][23][24][25], unknown: 1 [26]), mitral valve repair in 10 (21.3 %) [1,2,6,[27][28][29][30][31][32], and MVR after failure of repair in 1 (2.1 %) [33]. Of 37 patients who underwent MVR, 11 (29.7 %) had redo MVR [3, 5, 7-9, 11, 16, 18-20].…”