Vincentelli Andre, Juthier Francis, Letourneau Thierry, Tribouilloy Christophe, Prat Alain
Clinique de Chirurgie Cardio-Vasculaire, Cardiologic Hospital, Lille, South Hospital, Amiens, France.
J Heart Valve Dis. 2005 Nov;14(6):780-2.
Inverted left atrial appendage (ILAA) is a rare manifestation. The case is reported of a patient with a history of factor V Leiden who underwent a Ross operation. An intra-atrial mass was discovered one month postoperatively and suspected to be a thrombus. Despite six months' anticoagulant treatment, the intra-atrial mass persisted. Ultimately, the patient was reoperated on due to hemostatic risks factors, and an ILAA was found. The diagnosis of ILAA remains a major challenge. Despite widespread use of postoperative echocardiography, the few reported cases confirm ILAA to be a rare phenomenon. The finding at post-cardiotomy echocardiography of a left atrial mass associated with an absence of the left appendage is highly suggestive of a diagnosis of ILAA. As the incidence of complications remains to be defined, treatment remains controversial, but embolic risk factors such as hemostatic disease or atrial fibrillation invariably lead to surgery. In an asymptomatic patient without thromboembolic risks factors, a conservative approach should be considered, because of the risk of reoperation.
左心房附件倒置（ILAA）是一种罕见的表现。本文报告了一例有因子V莱顿病史且接受了罗斯手术的患者。术后一个月发现心房内有肿物，怀疑是血栓。尽管进行了六个月的抗凝治疗，心房内肿物仍然存在。最终，由于存在止血风险因素，患者接受了再次手术，结果发现是左心房附件倒置。ILAA的诊断仍然是一项重大挑战。尽管术后超声心动图被广泛使用，但少数报告病例证实ILAA是一种罕见现象。心脏切开术后超声心动图发现左心房肿物且左心耳缺失，这强烈提示ILAA的诊断。由于并发症的发生率仍有待确定，治疗仍存在争议，但诸如止血疾病或房颤等栓塞风险因素总是导致手术。对于无症状且无血栓栓塞风险因素的患者，由于再次手术的风险，应考虑采取保守方法。
