Buttar Sana N, Andersen Henrik Ø, Poulsen Jesper B, Thyregod Hans Gustav H
Department of Cardiothoracic Surgery, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Department of Cardiothoracic-Anesthesia, University Hospital of Copenhagen, Rigshospitalet, Denmark.
Eur Heart J Case Rep. 2022 Jun 21;6(7):ytac241. doi: 10.1093/ehjcr/ytac241. eCollection 2022 Jul.
Inverted left atrial appendage (ILAA) is a rare condition following cardiac surgery. Failure to recognize the condition or making misdiagnosis of a tumour, a thrombus or vegetation can lead to unnecessary and potentially adverse events. We present a case of ILAA after surgical repair of an atrial septal defect (ASD) in a young female.
A 3-year-old caucasian female was admitted for surgical repair of an ASD. The intraoperative course was uneventful until the opening of the right atrium (RA) after the commencement of cardiopulmonary bypass (CPB) and vacuum application, where the inferior vena cava (IVC) cannula was seen displaced in the RA. Cannula was repositioned, and ASD was repaired. On post-CPB transesohageal echocardiography (TEE), a newly developed mass was revealed in the left atrium (LA). The heart was re-arrested, and LA was re-assessed with unexpected finding of ILAA. ILAA was everted. RA was closed and CPB weaned off. Repeated post-CPB TEE showed no mass in the LA. No recurrence of mass was demonstrated on follow-up transthoracic echocardiography (TTE).
The incidence of ILAA is rare. Therefore, it is usually forgotten and not anticipated as a complication during heart surgery using CPB. In our case, dislodgement of the IVC cannula into the RA in combination with vacuum application in the setting of an ASD may have resulted in ILAA. This has not been reported in previous cases. ILAA should be suspected on intraoperative TEE if the mass is newly developed. Visual inspection of the left atrium appendage (LAA) is recommended before chest closure.
左心耳倒置（ILAA）是心脏手术后一种罕见的情况。未能识别这种情况或误诊为肿瘤、血栓或赘生物可能导致不必要的潜在不良事件。我们报告一例年轻女性房间隔缺损（ASD）手术修复后发生ILAA的病例。
一名3岁白种女性因ASD手术修复入院。在开始体外循环（CPB）并应用负压后，直到打开右心房（RA）之前，手术过程均顺利，此时发现下腔静脉（IVC）插管在RA内移位。重新放置插管，修复ASD。在CPB后经食管超声心动图（TEE）检查时，发现左心房（LA）有一个新出现的肿块。心脏再次停搏，重新评估LA时意外发现ILAA。将ILAA翻转。关闭RA，撤离CPB。CPB后再次进行TEE检查显示LA内无肿块。随访经胸超声心动图（TTE）未显示肿块复发。
ILAA的发生率很低。因此，在使用CPB的心脏手术中，它通常被遗忘且未被预期为一种并发症。在我们的病例中，IVC插管移位至RA并在ASD情况下应用负压可能导致了ILAA。此前病例中尚未有此报道。如果术中TEE发现新出现的肿块，应怀疑有ILAA。建议在关闭胸腔前对左心耳（LAA）进行目视检查。
