title: Left atrial dissection: an almost unknown entity.
abstract: Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheter-based interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection.
authors.affiliation: Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA shin922@gmail.com.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Kamellia R
authors.initials: KR
authors.lastname: Dimitrova
authors.affiliation: Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Geller
authors.affiliation: Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Darryl M
authors.initials: DM
authors.lastname: Hoffman
authors.affiliation: Division of Cardiac Surgery, Beth Israel Medical Center, New York, NY, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tranbaugh
mesh_terms: D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D006322:Heart Aneurysm / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D015994:Incidence; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Left atrial dissection; Mitral valve surgery; Transoesophageal echocardiography