Invited Commentary

Abstract

Dr Gillinov discloses financial relationships with Edwards, AtriCure, Intuitive, and Medtronic. Dr Gillinov discloses financial relationships with Edwards, AtriCure, Intuitive, and Medtronic. Dr Fukuhara and colleagues describe a small series of patients with left atrial dissection, a rare but relevant complication of mitral valve operations [1Fukuhara S. Dimitrova K.R. Geller C.M. Hoffman D.M. Ko W. Tranbaugh R.F. Left atrial dissection: etiology and treatment.Ann Thorac Surg. 2013; 95: 1557-1562Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar]. The incidence of diagnosis of left atrial dissection increases along with the skill of the transesophageal echocardiography operators in operating rooms. In our experience, not every left atrial dissection diagnosed intraoperatively requires revision and left atrial reconstruction. Often left atrial dissection presents as a discrete thickening of the left atrial wall with no hemodynamic influence on mitral valve function. In such cases, dissection can be successfully treated by heparin reversal. Left atrial dissections can also present as an overture to the life-threatening disruption of the atrioventricular junction, requiring immediate intraoperative repair. It is important to differentiate between these two entities because they are associated with substantially different prognoses. Perforation of the coronary sinus can lead to the formation of epicardial hematoma or, in rare cases, as described in this article, to left atrial dissection. The reason for the complication is likely related not to simple perforation of the low-pressured coronary sinus but rather to the pressurized infusion of cardioplegia through a displaced retrograde cardioplegia catheter. Early recognition of a misplaced retrograde cardioplegia catheter prevents this rare complication. Left Atrial Dissection: Etiology and TreatmentThe Annals of Thoracic SurgeryVol. 95Issue 5PreviewLeft atrial dissection (LatD) is a rare entity most commonly associated with mitral valve surgery. We have reviewed our experience with 4 patients to better define the etiology and the treatment of LatD. Full-Text PDF