Rapidly Vanishing Left Atrial Dissection Following Mitral Valve Replacement: A Case Report
Morishita, A., Katahira, S., Hoshino, T., Hanzawa, K., & Tomioka, H. (2020). Rapidly vanishing left atrial dissection following mitral valve replacement: a case report. Journal of cardiothoracic surgery, 15(1), 73. https://doi.org/10.1186/s13019-020-01112-3
View Original Source →Abstract
BACKGROUND: Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. non-surgical) for left atrial dissection has not been fully established yet. CASE PRESENTATION: Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the non-surgical treatment of left atrial dissection. CONCLUSIONS: It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.
Case Details
Disease Location
Heart
Personal Characteristics
68-year-old woman, previously been treated for breast and colon cancer
Clinical Characteristics
Presented with dyspnea at rest for approximately 2 months nyha iii. Grade IV/vi pan-systolic murmur at apex, pulse rate was 105. She was diagnosed with tachycardia. Chest radiograph revealed severe cardiomegaly with a cardiothoracic ratio of 80%, while an electrocardiogram showed persistent atrial fibrillation with a low-voltage f-wave. CT showed the retention of pleural fluid and hepatosplenomegaly. Transthoracic echocardiography revealed severe mitral regurgitation with annular enlargement and severe tricuspid regurgitation. The left ventricular ejection fraction was 49%, the left ventricular diastolic diameter was 63 mm, and the left atrial diameter was 71 mm. N-terminal prob-type natriuretic peptide level was elevated. The mitral valve was replaced with a 29-mm st. Jude mechanical valve. Tricuspid annuloplasty was performed with a 32-mm carpentier-edwards physiotricuspid ring. After closing the thorax, an atrial mass of 3 cm × 2 cm was detected by transesophageal echocardiography which showed an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. The mass was diagnosed as left atrial dissection"
Remission Characteristics
On postoperative day 2, tee showed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium had normalized completely, leaving no traces of lad.
Treatment & Mechanisms
Proposed Remission Mechanisms
The disappearance of the dissected cavity was rapid, because the pressurizing force from the left ventricle was applied between the left atrial myocar- dium and left atrial endocardium through the atrioven- tricular disrupted tissue
Clinical Treatment
Valve replacement