Allencherril J, Allencherril R, Joseph L. Left Atrial Intramural Hematoma After Surgical Aortic Valve Replacement. Methodist DeBakey Cardiovasc J. April 2017;13(2):81." /> Allencherril J, Allencherril R, Joseph L. Left Atrial Intramural Hematoma After Surgical Aortic Valve Replacement. Methodist DeBakey Cardiovasc J. April 2017;13(2):81."> Article Full Text – Methodist Journal
Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

See More
RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

See More

REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

Cholesterol: Can’t Live With It, Can’t Live Without It

CASE REPORTS See More

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

Vol 13, Issue 2 (2017)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Left Atrial Intramural Hematoma After Surgical Aortic Valve Replacement

Jump to:
Article Citation:

Allencherril JAllencherril R, Joseph L. Left Atrial Intramural Hematoma After Surgical Aortic Valve Replacement. Methodist DeBakey Cardiovasc J. April 2017;13(2):81.

doi: https://doi.org/10.14797/mdcj-13-2-81

Keywords
cardiopulmonary bypass ,  thoracic surgical procedure ,  intraoperative complications ,  left atrium ,  aortic valve stenosis ,  transesophageal echocardiography ,  transthoracic echocardiography ,  hematoma

A 64-year-old gentleman with severe aortic stenosis was admitted for surgical aortic valve replacement. A bioprosthetic valve was implanted. Intraoperative transesophageal echocardiogram (TEE) immediately after cardiopulmonary bypass showed a well-seated bioprosthetic aortic valve with trivial intravalvular aortic insufficiency and no perivalvular leaks. The other cardiac valves showed normal function. Normal left ventricular (LV) and right ventricular (RV) systolic functions were noted, with no regional wall motion abnormalities.

The patient came off bypass uneventfully, and the chest was closed. At this time, TEE demonstrated interval development of a mass in the posterolateral part of the left atrium, adjacent to the left atrial appendage and left upper pulmonary vein and extending to the coronary sinus (Figure 1, Videos 1–3). Consequently, the patient went back on cardiopulmonary bypass for further exploration, during which the surgical team discovered an intramural hematoma with no active hemorrhage. The hematoma was thought to be secondary to surgical trauma. TEE showed that valvular and ventricular function was unchanged.

Reports of left atrial intramural hematomas as a complication of cardiac valve surgery are exceedingly rare. The patient exhibited stable hemodynamics, and a conservative approach was deemed appropriate with planned future reassessment by echocardiography. The patient had a benign perioperative course and was discharged home. He was doing well at 4-month follow up. Transthoracic echocardiography at that time showed resolution of the hematoma.

Left atrial intramural hematoma on TEE
Figure 1. Intraoperative transesophageal echocardiogram illustrating the left atrial intramural hematoma in the (A, B) midesophageal four-chamber view, (C) midesophageal two-chamber view, and (D) midesophageal coronary sinus view. The arrows indicate the hematoma. CS: coronary sinus. Videos are available on the journal website.

Add Comments

Please login to dialogue with author.

Comments