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Left atrial dissection: etiology and treatment
Shinichi Fukuhara1, Kamellia R Dimitrova, Charles M Geller
1Division of Cardiothoracic Surgery, Beth Israel Medical Center, New York, NY 10003, USA. shin922@gmail.com
The Annals of Thoracic Surgery
|March 5, 2013
Summary
Left atrial dissection (LatD) is a rare cardiac surgery complication. Prompt diagnosis and repair, or nonoperative management for delayed cases, are essential for successful treatment and patient recovery.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Complications
- Atrial Pathologies
Background:
- Left atrial dissection (LatD) is a rare complication, primarily associated with mitral valve surgery.
- This study reviews 4 cases to define the etiology and treatment of LatD.
- Incidence rates: 0.02% after isolated CABG, 0.16% after mitral valve surgery.
Observation:
- Four patients (ages 49-80) experienced LatD post-cardiac surgery.
- Three patients had mitral valve procedures; one had emergent CABG.
- LatD occurred intraoperatively in three cases and 12 days post-mitral repair in one.
Findings:
- All LatDs were located on the posterior atrial wall, obstructing mitral inflow.
- Surgical repair involved hematoma evacuation, false lumen obliteration, and entry point repair.
- One delayed LatD was successfully managed nonoperatively.
Implications:
- Intraoperative diagnosis and repair are crucial for acute LatD.
- Nonoperative management may be suitable for stable, delayed LatD cases.
- Understanding LatD etiology aids in preventing and managing this rare complication.
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