Inverted Left Atrial Appendage Research Articles

Inversion of the Left Atrial Appendage

An 8-year-old girl with hypoplastic left heart syndrome underwent orthotopic heart transplantation for end-stage right ventricular dysfunction, after previous surgical palliations with the modified Norwood and Glenn procedures. The donor heart was transplanted into the recipient with the use of a bicaval anastomosis. Postoperative transesophageal echocardiography was noteworthy for a prominent tubular-shaped structure within the left atrium (Figure 1A through 1C and Movies I and II in the online-only Data Supplement), in proximity to the mitral valve orifice. Doppler color-flow mapping suggested no flow within the structure. The patient’s marginal hemodynamic status after separation from cardiopulmonary bypass resulted in a decision to pursue delayed sternal closure, and the structure was not addressed at the time of transplantation. Figure 1. Multiplane transesophageal still-frame echocardiographic images from the midesophageal 0° 4-chamber view ( A ), midesophageal 71° view focusing on the right ventricular outflow tract ( B ), and midesophageal 109° view focusing on the left ventricular outflow tract ( C ) with Doppler color-flow mapping. In each image, the inverted left atrial appendage is the tubular structure denoted with an asterisk. Note the absence of color flow through the inverted left atrial appendage in C . D , Transthoracic still-frame echocardiographic image …

Inverted Left Atrial Appendage Bonded to Atrial Septum

Inverted left atrial appendage (LAA) is a rare surgical complication. Our patient, a boy aged 2 years, was diagnosed with a partial atrioventricular defect with mild regurgitation of the left atrioventricular valve and a large primum atrial septal defect. Direct postoperative transesophageal echocardiography revealed a new left atrial mass attached to the atrial septum, without left ventricle inflow obstruction. Out of concern about the nature of this mass, we chose surgical direct examination. Intraoperatively, we diagnosed it as an inverted LAA accidentally attached to the atrial septum suture line. Awareness of this condition can avoid unnecessary diagnostic and therapeutic procedures.

Inverted Left Atrial Appendage Masquerading as a Cardiac Mass

An inverted left atrial appendage is a rare phenomenon post cardiac surgery. The lesion presents as an additional mass in the left atrium, which would trigger unnecessary concerns and frequently, a battery of tests. The lesion can be easily diagnosed using echocardiography. We report a case of inverted left atrial appendage in a patient post repair of common arterial trunk. Echocardiographic pictures and features which help to identify this lesion as well as to differentiate it from other possible left atrial mass are described. This article aimed to improve the awareness of sonographers toward this rare but possible post operative lesion.

Inversion of the Left Atrial Appendage: A Complication of Cardiac Surgery

An inverted left atrial appendage which fails to revert spontaneously is a rare complication of cardiac surgery. We present a case of an inverted left atrial appendage discovered intraoperatively on transoesophageal echocardiography. This was readily identified and was easily corrected with digital manipulation. Intraoperative transoesophageal echocardiography plus an awareness of the possibility that a newly presenting left atrial mass post-bypass might be an inverted left atrial appendage, facilitates immediate correction. So doing removes any need for further investigation or further cardiac surgery and reduces the risk of a subsequent thromboembolic event if the diagnosis is not made until later.

Inverted left atrial appendage presenting as a large left atrial mass.

Inverted left atrial appendage (ILAA) is a rare phenomenon. We describe a patient with mitral stenosis who presented with a homogenous mass in the left atrium, mimicking a large thrombus. The patient was sent to surgery and no thrombus was found; intraoperative examination by the surgeon revealed an ILAA. We briefly discuss the main features of this entity and also some aspects of the differential diagnosis.

Inversion of the Left Atrial Appendage Misdiagnosed as a Thrombus following Cardiac Surgery: A case report

Transesophageal echocardiography (TEE) is now a common part of intraoperative monitoring in cardiac surgery. Intraoperative TEE offers substantial utility in detection of residual problems requiring reoperation. This report describes a 23 month old patient who was operated on for ventricular septal defect (VSD). TEE following VSD closure revealed a large thrombus in the left atrium (LA). Because of concern about the risk of thromboembolism, the LA was about to be re-explored after TEE demonstration. However, examination by the surgeon as compared with TEE revealed the mass to be an inverted left atrial appendage (LAA) that was easily everted, resulting in the disappearance of this mass on TEE. Echocardiographically, the inverted LAA appears as a mass mimicking a thrombus, a vegetation of the left atrium. Lack of awareness of this entity can result in a misdiagnosis and unnecessary procedures.

De novo inverted left atrial appendage: an unrecognized cause of left atrial mass with symptoms mimicking myxoma

J Thorac Cardiovasc Surg 2001;121:1211-3

Inverted left atrial appendage: an unusual complication in cardiac surgery

Two patients with an inverted left atrial appendage after cardiac surgery were presented. Magnetic resonance imaging is one of the useful methods to establish an accurate diagnosis of this complication. In 1 patient, it repaired spontaneously without surgical intervention.

Inverted left atrial appendage mimicking a left atrial mass during mitral valve repair

This case report describes the appearance of a new homogenous mass seen in the left atrium on intraoperative transesophageal echocardiography after mitral valve repair. This "mass" was the inverted left atrial appendage. Echocardiographers need to recognize normal variants, such as an inverted left atrial appendage, to avoid misdiagnosis.

Inverted left atrial appendage presenting as an unusual left atrial mass

An unusual left atrial mass in an infant after repair of truncus arteriosus was imaged by transthoracic and transesophageal echocardiography. The mass was identified as an inverted left atrial appendage, and the patient underwent uncomplicated surgical eversion. Unnecessary anticoagulation was avoided.

Technical advances in the Senning operation.

Since March 1978, 59 patients with transposition of the great arteries (TGA) ranging in age from 2 months to 6 years have undergone the Senning operation. Forty-six patients (77.9%) had transposition with intact ventricular septum, 8 of them with patent ductus arteriosus; 8 patients (13.5%) had TGA with ventricular septal defect (VSD), 3 of them with previously performed banding; 4 patients (6.7%) had TGA with VSD and pulmonary stenosis (PS), and one (1.6%) had TGA with PS. Prior to correction, 38 cases had undergone a Rashkind septotomy and 15 had had a previous Blalock-Hanlon septectomy. During this time we have introduced some technical modifications of the original Senning operation: (A) right atrial incision, (B) large left atrial wall window, (C) infrasinal suture of the left atrial flap, (D) avoidance of damage to the hypothetical anterior atrioventricular conduction bundle, and recently, in 12 patients, we have used (E) an inverted left atrial appendage as an interatrial flap. There were 9 hospital deaths (15.2%) caused by low cardiac output (4 cases), severe hypoxemia and low cardiac output (4 cases) and one patient with pulmonary venous drainage obstruction died following reoperation. Two patients developed neurological complications that disappeared without sequela. Another complication was a right chylothorax (4 patients), which improved without the necessity of surgical repair. Eighteen patients developed a junctional rhythm for a period over 24 hours. We think that the technical modifications which we present here, partially contribute to improving the Senning operation.