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J Thorac Cardiovasc Surg 2004;127:596-597
© 2004 The American Association for Thoracic Surgery

Brief communication

Left atrial dissection after mitral operation mimicking severe mitral regurgitation

^a Department of Cardiovascular Surgery, University Hospital, Giessen, Germany

Received for publication July 21, 2003; revisions received September 16, 2003; accepted for publication October 8, 2003.

^* Address for reprints: Martin C. Heidt, MD, Department of Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-St 7, D-35392 Giessen, Germany
Martin.C.Heidt@innere.med.uni-giessen.de

The first 20% of the full text of this article appears below.

A 67-year-old patient underwent mitral valve reconstruction consisting of quadrangular resection at the P2 segment and implantation of a flexible 29-mm Duran annuloplasty ring (Medtronic, Inc, Minneapolis, Minn). Five days after surgery, transesophageal echocardiography (TEE) revealed left atrial dissection that was causing severe paravalvular regurgitation because of a reentry in the left atrial dissection membrane. The mitral leaflets still demonstrated appropriate coaptation within the annuloplasty ring.

Clinical summary

This patient presented with dyspnea and was in New York Heart Association class III. Echocardiography revealed degenerative mitral valve disease with mitral regurgitation grade 3 resulting from chordal rupture and subsequent posterior leaflet prolapse at the P2 segment. The mitral valve annulus was enlarged. The left ventricular ejection fraction was 75%, and the diastolic diameter was 60 mm. The left atrial diameter was 45 mm. Coronary angiography results were normal.

Mitral reconstruction was performed. This consisted of quadrangular resection of the prolapsing P2 segment, annular reconstruction with 2 annular compression sutures at the site of the leaflet resection, leaflet reconstruction with single sutures, and . . . [Full Text of this Article]

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