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Case Reports
. 2023 Feb 15;18(1):75.
doi: 10.1186/s13019-022-02097-x.

Left atrial dissection after a supra-annular mitral valve replacement for endocarditis

Valentin de Villiers de la Noue  1 , Guillaume Théry  2 , Laurent Faroux  3 , Nasreddine Belkessa  4 , Sylvain Rubin  5 , Bruno Mourvillier  1 , Antoine Goury  1
Affiliations
Case Reports

Left atrial dissection after a supra-annular mitral valve replacement for endocarditis

Valentin de Villiers de la Noue et al. J Cardiothorac Surg. .

Abstract

Background: Left atrial dissection is a rare and a potentially fatal complication of cardiac surgery. Multi-modal imagery is helpful for the diagnosis and to guide the treatment.

Case presentation: We report the case of a 66-year-old female patient who underwent a combined mitral and aortic valve replacement for degenerative valvular disease. She presented an infectious endocarditis revealed by a third-degree atrioventricular bloc and had a redo mitral- and aortic valve replacement. Mitral valve was inserted in supra-annular position due to annular destruction. Post-operative course was marked by a refractory acute heart failure explained by a left atrial wall dissection confirmed by transoesophageal echocardiography and synchronized cardiac CT-scan. Surgical treatment was theoretically indicated but considering the high risk of a third surgery, a palliative care support was collegially decided.

Conclusions: Left atrial dissection can occur after a redo surgery and supra-annular mitral valve implantation. Multi-modal imagery including transoesophageal echocardiography and cardiac CT-scan is helpful for the diagnosis.

Keywords: Cardiac CT-scan; Left atrial dissection; Transoesophageal echocardiography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Left atrial dissection visualized in transesophageal echocardiography. a, b, d Mid-oesophageal 4-chamber view, the false aneurysm is squeezing the left atrium in systole (a, b), and drained in the left ventricle in diastole (d). c Mid-oesophageal 4-chamber view with colour-doppler illustrating the para-valvular leakage. e, f mid-oesophageal 4-chamber view in systole (f) and diastole (e). FA: false aneurysm, LA: left atrium, LV: left ventricle, RA: right atrium
Fig. 2
Fig. 2
Transgastric transoesophageal echocardiography views; the false aneurysm is developed behind the prosthetic mitral valve and the left atrium. FA: false aneurysm, PAV: prosthetic aortic valve, PMV: prosthetic mitral valve
Fig. 3
Fig. 3
Cardiac CT-scan and 3D-reconstruction. The false aneurysm measures 65 × 40 × 30 mm, behind the prosthetic mitral valve and the left atrium. FA: false aneurysm, LA: left atrium, LV: left ventricle, PAV: prosthetic aortic valve, PMV: prosthetic mitral valve
See this image and copyright information in PMC

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