Category: General

Gen Thorac Cardiovasc Surg Cases. 2025 Jan 15;4(1):4. doi: 10.1186/s44215-025-00188-4.

ABSTRACT

BACKGROUND: Left atrial dissection is a rare and occasionally fatal complication of cardiac surgery and is defined as the creation of a false chamber through a tear in the mitral valve annulus extending into the left atrial wall. Some patients are asymptomatic, while others present with various symptoms, such as chest pain, dyspnea, and even cardiac arrest. Although there is no established management for left atrial dissection, surgery should be considered in patients with hemodynamic disruption. Herein, we report a case of left atrial dissection managed using redo mitral valve replacement (MVR) with annular reconstruction.

CASE PRESENTATION: A 60-year-old man presented to our hospital with bilateral lower-extremity purpura and cognitive decline. Blood tests showed an elevated inflammatory response, and blood culture revealed Streptococcus mitis. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation with vegetation on both the anterior and posterior leaflets, and infective endocarditis was diagnosed. We performed minimally invasive cardiac surgery-MVR through a right mini thoracotomy using Epic mitral valve 29 mm (Abbott Laboratories, Green Oaks, IL, USA). On postoperative day (POD) 2, the patient was discharged from the intensive care unit (ICU). On POD 3, sudden cardiac arrest occurred; we started cardiopulmonary resuscitation and urgently inserted a peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannula. Contrast-enhanced computed tomography revealed extravasation from the posterior wall of the left atrium. Therefore, we performed an emergency median sternotomy, controlled the bleeding from the posterior wall of the left atrium, and returned the patient to the ICU with gauze packing under VA-ECMO. Two days later, when the gauze was removed, TEE revealed a false lumen on the left atrial wall, and left atrial dissection was diagnosed. Accordingly, we performed annular reconstruction with bovine pericardium to close the entry point and, in succession, redo MVR with a bioprosthetic Epic mitral valve 27 mm. The postoperative course was uneventful. The patient was transferred to a rehabilitation hospital on POD 74.

CONCLUSION: We report a case of left atrial dissection following MVR. The complex lesion was successfully repaired using redo MVR with annular reconstruction.

PMID:39815372 | PMC:PMC11734570 | DOI:10.1186/s44215-025-00188-4

JACC Case Rep. 2024 Nov 20;29(22):102762. doi: 10.1016/j.jaccas.2024.102762. eCollection 2024 Nov 20.

ABSTRACT

This case report presents a unique challenge of complete aortomitral curtain dehiscence and a large pseudoaneurysm 6 weeks post-aortic root replacement in a patient with infective endocarditis. It underscores the importance of meticulous follow-up in patients who have undergone complex aortic surgeries, especially those with infective endocarditis. The patient’s subtle symptoms of occasional dyspnea and lightheadedness highlight the necessity for a comprehensive evaluation and a high index of suspicion. The aortomitral curtain was successfully reconstructed using a bovine pericardial patch, managing the pseudoaneurysm and restoring heart structural integrity. This case also emphasizes the limitations of current diagnostic criteria for infective endocarditis in the presence of intracardiac prosthetic material, and the need for advanced imaging and interdisciplinary consultations to enhance diagnosis and patient management.

PMID:39691892 | PMC:PMC11646890 | DOI:10.1016/j.jaccas.2024.102762