Postoperative pulmonary hypertensive crisis caused by inverted left atrial appendage after cardiopulmonary bypass surgery for congenital heart disease in a neonate.
Postoperative pulmonary hypertensive crisis (PHC) caused by an inverted left atrial appendage (ILAA) is a rare complication following cardiac surgery. We present a case of 23 day-old male infant who developed postoperative PHC attacks after undergoing cardiopulmonary bypass (CPB) surgery for repair of the coactation of aorta. A hyperechogenic left atrial mass was detected via bedside transthoracic echocardiography (TTE), which was identified as an ILAA and corrected following repeat surgery. In this case, both the negative pressure in vent catheter and the long left atrial appendage (LAA) with a narrow base led to an irreversible ILAA. As in this neonate, ILAA had significant influence on the left atrial volume and caused PHC since the ILAA was located on the mitral valve orifice and interfered with the blood flow through the valve. Therefore, we recommend that the vent catheter should be turned off before removing to avoid this potential complication. Additionally, LAA should be carefully inspected after CPB surgery, and intra-operative and post-operative transoesophageal echocardiography (TEE) should be performed to detect ILAA intraoperatively so as to avoid the reoperation. When an ILAA is diagnosed postoperatively, whether conservative treatment or surgery will depend on the balance of benefit and risk for a particular patient.
Department of Cardiovascular and Thoracic Surgery, The 2nd Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical College, Wenzhou, China. Electronic address: zhaoqf1862@163.com.
Qifeng
Q
Zhao
Xingti
X
Hu
D020517:Atrial Appendage / Q000473:pathology / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery
Cardiopulmonary bypass (CPB); Congenital heart disease (CHD); Inverted left atrial appendage (ILAA); Neonate; Pulmonary hypertensive crisis (PHC)