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Updated: Apr 23, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Left atrial dissection: an almost unknown entity
Shinichi Fukuhara1, Kamellia R Dimitrova2, Charles M Geller2
1Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA shin922@gmail.com.
Insights
Left atrial dissection, a rare cardiac surgery complication, can cause severe hemodynamic compromise requiring urgent surgery. Non-operative management is an option for stable patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Biology
Background:
- Left atrial dissection is a rare but life-threatening complication following cardiac surgery.
- It is most frequently linked to mitral valve procedures, with an incidence of 0.16%.
Purpose of the Study:
- To review the incidence, pathogenesis, clinical course, management, and outcomes of left atrial dissection.
- To provide a comprehensive understanding of this rare clinical entity.
Main Methods:
- Literature review of case reports and studies on left atrial dissection.
- Analysis of reported incidence, predisposing factors, and clinical presentations.
- Evaluation of management strategies and patient outcomes.
Main Results:
- Dissection forms a cavity between left atrial layers, leading to hemodynamic compromise.
- Presentation timing varies widely, from immediate post-surgery to 20 years later.
- Hemodynamically unstable cases typically require immediate surgical intervention.
Conclusions:
- Left atrial dissection is a rare but significant complication of cardiac procedures.
- Management depends on hemodynamic stability, with surgery for instability and non-operative approaches for stable patients.
- Further research can improve understanding and treatment of this condition.
Abstract:
Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheter-based interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection.
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