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Left atrial dissection: pathogenesis, clinical course, and transesophageal echocardiographic recognition
P Gallego1, J M Oliver, A González
1Departments of Cardiology and Cardiovascular Surgery, La Paz General Hospital, Autonoma University, Madrid, Spain. pastoragallego@teleline.es
Insights
Left atrial dissection is a rare condition often linked to mitral valve replacement. Transesophageal echocardiography is key for diagnosing this and related complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Left atrial dissection is an uncommon cardiac condition.
- It is frequently associated with mitral valve replacement but has other potential causes.
- Understanding its pathogenesis is crucial for patient management.
Purpose of the Study:
- To review a series of 11 patients with pathologically confirmed left atrial dissection.
- To identify predisposing factors and pathogenic mechanisms.
- To explain the clinical course, hemodynamic impact, and echocardiographic features.
Main Methods:
- Pathological confirmation of left atrial dissection in 11 patients.
- Diagnosis established using transesophageal echocardiography (TEE).
- Review of predisposing factors, surgical findings, and clinical data.
Main Results:
- TEE identified a mobile intimal flap creating a false chamber.
- Accurate diagnosis of prosthetic valve function and endocarditis complications was achieved.
- Color flow Doppler revealed complications like mitral regurgitation and atrial shunts.
Conclusions:
- Left atrial dissection, though rare, requires consideration of various predisposing factors.
- Transesophageal echocardiography is highly effective for diagnosis and complication assessment.
- Associated conditions include endocarditis, myocardial infarction complications, and trauma.
Abstract:
Left atrial dissection is an uncommon entity. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis. We discuss a series of 11 patients with pathologically confirmed left atrial dissection who had been diagnosed previously by transesophageal echocardiography. Predisposing factors and surgical or pathologic findings were reviewed to identify the pathogenic mechanism and to explain the clinical course, hemodynamic disorder, and echocardiographic features. Dissection of the coronary sinus secondary to retrograde cardioplegia, endocarditis, cardiac rupture after myocardial infarction, and blunt chest trauma also could be related to its development. Transesophageal echocardiography identified a mobile intimal flap of the atrial wall that was creating a false chamber and allowed accurate diagnosis of prosthetic mitral valve function, endocarditis complications, and a left ventricular pseudoaneurysm after acute myocardial infarction. Color flow Doppler was particularly useful in identifying complications: communication between the false chamber and true left atria, permitting mitral regurgitation through the periannular route; development of atrial shunts; and severe tricuspid regurgitation caused by disruption of the anterior papillary muscle.