Morishita Atsushi, Katahira Seiichiro, Hoshino Takeshi, Hanzawa Kazuhiko, Tomioka Hideyuki
Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, 8 Sakae-cho, Numata, 378-0014, Japan.
Division of Health Administration, Hamakawasaki Operation Center, Toshiba Human Asset Service Corporation, Kawasaki, Japan.
J Cardiothorac Surg. 2020 May 6;15(1):73. doi: 10.1186/s13019-020-01112-3.
Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. non-surgical) for left atrial dissection has not been fully established yet.
Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the non-surgical treatment of left atrial dissection.
It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.
左心房夹层是二尖瓣置换术极为罕见的并发症。因其严重性，必须迅速诊断并治疗。对于左心房夹层最有效的治疗方法（即手术治疗与非手术治疗）尚未完全确立。
在此，我们报告了一名68岁肥胖女性二尖瓣置换术后发生左心房夹层的病例。关胸后，经食管超声心动图（TEE）显示一个3厘米×2厘米的心房肿物，呈椭圆形低回声，从二尖瓣后瓣环延伸至左心房后壁。由于血流动力学状况稳定，排除了手术治疗，选择密切观察的保守治疗。术后第2天，TEE显示心房肿物消失，仅残留的心内膜碎片在心房内飘动。术后第6天，左心房外观完全恢复正常，未留下左心房夹层的痕迹。患者顺利康复。在左心房夹层的非手术治疗过程中，连续TEE是一种非常有效的成像方式。
基于患者的血流动力学状况和连续TEE随访检查，准确界定诊断并优化左心房夹层的治疗策略至关重要。在我们的病例研究中，左心房夹层通过保守治疗成功治愈；因此，我们认为TEE可能是早期诊断这种疾病的一种可行方式。
