title: An inverted left atrial appendage mimicking an intraatrial thrombus after a ross operation.
abstract: 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.
authors.affiliation: Clinique de Chirurgie Cardio-Vasculaire, Cardiologic Hospital, Lille, South Hospital, Amiens, France. a-vincentelli@chru-lille.fr
authors.forename: Andre
authors.initials: A
authors.lastname: Vincentelli
authors.forename: Francis
authors.initials: F
authors.lastname: Juthier
authors.forename: Thierry
authors.initials: T
authors.lastname: Letourneau
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.forename: Alain
authors.initials: A
authors.lastname: Prat
mesh_terms: D020016:Activated Protein C Resistance / Q000150:complications; D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D020517:Atrial Appendage / Q000002:abnormalities* / Q000000981:diagnostic imaging; D003951:Diagnostic Errors; D004452:Echocardiography; D005165:Factor V / Q000235:genetics; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D011664:Pulmonary Valve / Q000637:transplantation*; D013927:Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: C095381:factor V Leiden; D005165:Factor V