Images in Cardiothoracic Medicine and Surgery
Delayed left atrial dissection after aortic valve replacement
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(7) 877 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314526397 aan.sagepub.com
Mehrnoush Toufan, Ahmad Separham and Leili Pourafkari
Figure 1. Transesophageal echocardiography showing the flap in the left atrium. The arrow points to the hole in the anterior leaflet of the mitral valve.
A 16-year-old boy presented with acute dyspnea after aortic valve replacement with a 21-mm mechanical prosthesis (St. Jude Medical) for infective endocarditis caused by Staphylococcus aureus 2 months earlier. The postoperative course had been uneventful and he had been discharged after a full course of antibiotic therapy. He had developed sudden worsening dyspnea the previous day, and was found to be diaphoretic and in respiratory distress with weak peripheral pulses and fine crackles half way up both lungs. Prosthetic valve malfunction was suspected. Transthoracic echocardiography showed a left ventricular ejection fraction of 45%, severe mitral valve regurgitation caused by a hole in the anterior leaflet of the mitral valve, moderate tricuspid regurgitation, and severe pulmonary hypertension. Transesophageal echocardiography revealed complete detachment of the intervalvular fibrous tissue and dissection of the anterior wall of the left atrium (Figure 1, Video 1 and 2 (supplementary material)). Partial dehiscence of the aortic prosthesis at posterior side of the sewing ring was also noted. Emergency surgery was scheduled but unfortunately, the patient died before surgery. Left atrial dissection is rarely encountered.
It is mainly associated with mitral valve surgery and has also been reported after left ventricular aneurysm repair, coronary artery bypass, aortic valve replacement, and infective endocarditis; it may also occur spontaneously. In this case, the invasive nature of endocarditis and probably inadequate debridement of the infective tissue led to left atrial dissection and perforation of the mitral valve leaflet, which presented as pulmonary edema and cardiogenic shock. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest statement None declared.
Cardiovascular Research Department, Tabriz University of Medical Sciences, Tabriz, Iran Corresponding author: Leili Pourafkari, MD, Cardiovascular Research Department, Tabriz University of Medical Sciences, Tabriz, Iran. Email: [email protected]
Downloaded from aan.sagepub.com at The University of Hong Kong Libraries on June 5, 2016
Delayed left atrial dissection after aortic valve replacement
Asian Cardiovascular & Thoracic Annals 2015, Vol. 23(7) 877 ß The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492314526397 aan.sagepub.com
Mehrnoush Toufan, Ahmad Separham and Leili Pourafkari
Figure 1. Transesophageal echocardiography showing the flap in the left atrium. The arrow points to the hole in the anterior leaflet of the mitral valve.
A 16-year-old boy presented with acute dyspnea after aortic valve replacement with a 21-mm mechanical prosthesis (St. Jude Medical) for infective endocarditis caused by Staphylococcus aureus 2 months earlier. The postoperative course had been uneventful and he had been discharged after a full course of antibiotic therapy. He had developed sudden worsening dyspnea the previous day, and was found to be diaphoretic and in respiratory distress with weak peripheral pulses and fine crackles half way up both lungs. Prosthetic valve malfunction was suspected. Transthoracic echocardiography showed a left ventricular ejection fraction of 45%, severe mitral valve regurgitation caused by a hole in the anterior leaflet of the mitral valve, moderate tricuspid regurgitation, and severe pulmonary hypertension. Transesophageal echocardiography revealed complete detachment of the intervalvular fibrous tissue and dissection of the anterior wall of the left atrium (Figure 1, Video 1 and 2 (supplementary material)). Partial dehiscence of the aortic prosthesis at posterior side of the sewing ring was also noted. Emergency surgery was scheduled but unfortunately, the patient died before surgery. Left atrial dissection is rarely encountered.
It is mainly associated with mitral valve surgery and has also been reported after left ventricular aneurysm repair, coronary artery bypass, aortic valve replacement, and infective endocarditis; it may also occur spontaneously. In this case, the invasive nature of endocarditis and probably inadequate debridement of the infective tissue led to left atrial dissection and perforation of the mitral valve leaflet, which presented as pulmonary edema and cardiogenic shock. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest statement None declared.
Cardiovascular Research Department, Tabriz University of Medical Sciences, Tabriz, Iran Corresponding author: Leili Pourafkari, MD, Cardiovascular Research Department, Tabriz University of Medical Sciences, Tabriz, Iran. Email: [email protected]
Downloaded from aan.sagepub.com at The University of Hong Kong Libraries on June 5, 2016
