Vol 29, No 3 (2022)
Image in Cardiovascular Medicine
Published online: 2022-05-31

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Left atrial dissection due to massive atrioventricular separation following a redo mitral valve replacement

Ziming Zhang1, Yuman Li12, Li Zhang12, Mingxing Xie12
Pubmed: 35652137
Cardiol J 2022;29(3):517-518.

Abstract

Not available

IMAGE IN CARDIOVASCULAR MEDICINE

interventionAL CARDIOLOGY

Cardiology Journal 2022, Vol. 29, No. 3, 517–518

DOI: 10.5603/CJ.2022.0037 Copyright © 2022 Via Medica

ISSN 1897–5593 eISSN 1898018X

Left atrial dissection due to massive atrioventricular separation following a redo mitral valve replacement

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Ziming Zhang*12Yuman Li*12Li Zhang12Mingxing Xie12
1Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
2Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China

Address for correspondence: Mingxing Xie, MD, PhD, Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan 430022, China, tel: 86-27-85726430, fax: 86-27-85726386, e-mail: xiemx@hust.edu.cn

Received: 12.07.2021 Accepted: 8.08.2021

*These authors contributed equally to this manuscript.

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 55-year-old man with severe mitral valve regurgitation was admitted to our hospital and was scheduled for mitral valve replacement (MVR). He had undergone a Bentall surgery 3 years earlier due to aortic dissection. MVR with mechanical prosthetic valve was performed. Three days after surgery, hemoglobinuria was noticed. Bedside transthoracic echocardiography (TTE) showed a severe peri-prosthetic mitral leak and an emergency surgery of a redo MVR with mechanical prosthetic valve was performed. Post-bypass transesophageal echocardiography confirmed prosthetic valve with normal function. On postoperative day 5, acute hemodynamic deterioration occurred. His oxygen saturation was 88%, blood pressure was 85/43 mmHg. Bedside TTE revealed a severe atrioventricular disruption causing left atrial (LA) dissection (Fig. 1A, Suppl. Video 1). There was a markedly rocking motion of the mechanical mitral valve. Color flow Doppler imaging showed that the dissected cavity directly communicated with left ventricle via a massive atrioventricular separation, through which it received blood during left ventricular systole. In addition, the dissected cavity also communicated with the true left atrium through a 9-mm defect (Fig. 1B). With the use of a three-dimensional TTE, the dissected LA wall was displayed intuitively and the extent of atrioventricular separation was more readily appreciated (Fig. 1C, D). Patient died due to low cardiac output on the 6th day after surgery.

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Figure 1. A. Bedside transthoracic echocardiography (TTE) revealing a severe atrioventricular disruption and left atrial dissection (arrows) in the apical 4-chamber view; B. Color Doppler imaging shows that the dissected cavity directly communicated with left ventricle via a massive atrioventricular separation. The dissected cavity also communicated with true left atrium through a 9-mm defect (arrow); C. Three-dimensional TTE intuitively displaying the dissected left atrium wall; D. Three-dimensional TTE from the left ventricular perspective showing the extent of atrioventricular separation (9.3 cm2); LA — left atrium; LV — left ventricle; RA — right atrium; RV — right ventricle.

Left atrial dissection is an extremely rare complication after mitral valve surgery with an incidence of 0.84%. We report a rare case of LA dissection due to severe atrioventricular separation after a redo MVR.

Funding: The study was supported by National Key R&D Program of China (Grant Nos. 2018YFC0-114600) and the National Natural Science Foundation of China (Grant Nos. 81727805, 81922033, 81401432), the Key Research and Development Program of Hubei (Grant Nos. 2020DCD015, 2021BCA138).

Conflict of interest: None declared