Related Experiment Video
Updated: May 13, 2026
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
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
Insights
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.
Background:
Left atrial dissection (LatD) is a rare entity most commonly associated with mitral valve surgery. We have reviewed our experience with 4 patients to better define the etiology and the treatment of LatD.
Methods:
From 1991 to 2012, 4 patients experienced LatD after surgery (1 of 6,302, or 0.02%, of isolated coronary artery bypass grafting patients and 3 of 1,895, or 0.16%, of mitral valve patients). Patient and perioperative data and management were reviewed.
Results:
Two patients were women, and ages ranged from 49 to 80 years. Three patients underwent mitral procedures (two replacements with coronary artery bypass grafting and one repair) for mitral regurgitation. One patient underwent emergent isolated coronary artery bypass grafting after cardiopulmonary resuscitation for a left main dissection during percutaneous coronary intervention. Three LatDs were found during surgery, and one LatD was found 12 days after mitral repair and was successfully treated nonoperatively. The LatD was located along the posterior atrial wall originating from the atrioventricular junction in all cases and obstructed mitral valve inflow. Operative repair focused on the evacuation of hematoma, obliteration of the false lumen, and repair of the entry injury. No mortality occurred.
Conclusions:
Left atrial dissection is a rare complication of cardiac surgery, probably related to a contained atrioventricular separation allowing pressurized blood to separate the layers of the posterior left atrium. Prompt intraoperative diagnosis, obliterating the false cavity, and addressing the entry point are essential. In contrast, a nonoperative approach in a stable patient with a delayed LatD suggests healing of the dissection, and atrial remodeling occurs.
Related Concept Videos
01:25Aortic Regurgitation III: Medical Management
01:15Aortic Regurgitation I: Introduction
01:26Mitral Stenosis III: Medical Management
01:22Mitral Stenosis I: Introduction
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias