3D imaging of left atrial dissection: a case report

Area of Science:

• Cardiovascular Surgery
• Medical Imaging

Background:

• Left atrial dissection (LAD) is an uncommon yet serious complication following cardiac surgery.
• Treatment decisions for LAD require careful assessment due to varying clinical presentations.
• Advanced imaging modalities are crucial for detailed evaluation in complex LAD cases.

Purpose of the Study:

• To present a case of LAD following total arch replacement (TAR).
• To highlight the utility of 3D imaging in assessing and managing LAD.
• To discuss the conservative management of LAD in a frail patient.

Main Methods:

• A 79-year-old male patient underwent TAR for aortic aneurysm.
• Intraoperative transesophageal echocardiography (TEE) detected LAD.
• ECG-gated 3D-CT and follow-up 3D-TEE were used for detailed assessment and monitoring.

Main Results:

• A conservative strategy was chosen for LAD management due to patient frailty.
• 3D-CT revealed LAD occupied 26% of left atrial volume and its relation to pulmonary veins and coronary sinus.
• Follow-up imaging showed LAD hematoma absorption and eventual disappearance of LAD.

Conclusions:

• 3D imaging techniques (3D-TEE, 3D-CT) are invaluable for assessing LAD volume, quality, and spatial relationship.
• These advanced imaging tools aid in determining LAD etiology, predicting hemodynamic impact, and guiding treatment strategies.
• 3D imaging is particularly potent in managing complex LAD cases.