J Cardiovasc Ultrasound.  2014 Sep;22(3):155-157. 10.4250/jcu.2014.22.3.155.

Infective Left Atrial Dissecting Flap after Cardiac Surgery

• Nabati M
• Tabiban S
• Ghaemian A
• Bagheri B
• Shokri M

• KMID: 2045434
• DOI: http://doi.org/10.4250/jcu.2014.22.3.155

Abstract

Left atrial dissection (LatD), defined as the forced separation of the left atrial (LA) wall layers by blood, is a rare and severe complication of cardiac surgery. It is most frequently associated with atrioventricular junction injuries. We report a case of infected LatD after coronary artery bypass graft, mitral valve replacement, aortic valve replacement and ascending aortic root replacement. The patient was presented with septicemia and disseminated intravascular coagulation. To the best of our knowledge, this is the first case report of LA dissecting flap concomitant with attached infective vegetations identified by transesophageal echocardiography.

Keyword

Atrial dissection; Transesophageal echocardiography; Mitral valve; Prosthesis; Infective endocarditis

MeSH Terms

Aortic Valve
Coronary Artery Bypass
Disseminated Intravascular Coagulation
Echocardiography, Transesophageal
Endocarditis
Humans
Mitral Valve
Prostheses and Implants
Sepsis
Thoracic Surgery*
Transplants

Figure

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  Fig. 1 An electrocardiogram revealed atrial fibrillation rhythm, normal axis and non-specific ST-T changes in inferior and lateral leads.

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  Fig. 2 Transesophageal echocardiography in mid esophageal four chamber view (0 degree) demonstrated a linear dissecting flap and its attached (irregular shaped) particles originated from left atrial wall. LA: left atrium, LV: left ventricle, MV: mitral valve, RA: right atrium, RV: right ventricle.

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  Fig. 3 Transesophageal echocardiography in mid esophageal two chamber view (106 degree) demonstrated a linear dissection flap originated from posterior side of left atrial wall. LA: left atrium, LV: left ventricle, MV: mitral valve.

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  Fig. 4 Transesophageal echocardiography in mid esophageal two chamber view (97 degree) demonstrated a linear dissection flap originated from posterior side of left atrial wall. LA: left atrium, LV: left ventricle, MV: mitral valve.

Reference

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