Percutaneous Closure of an Atrioventricular Groove Rupture Causing a Left Atrial Dissection After Cardiac Surgery

Figures

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  Figure 1. Intraoperative Transesophageal Echocardiography Showing a False Cavity Within the Left Atrium Consistent With a Left Atrial Dissection (Asterisk) (A) Color Doppler imaging with high-velocity systolic jet originating from the left ventricle (solid arrow) and entering the false lumen through a tear located at the posteromedial mitral annulus. (B) Color Doppler imaging with a small residual fenestration (dotted arrow) of the interatrial septum with a left-to-right shunt between the false lumen and the right atrium.

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  Figure 2. 3-Dimensional Transesophageal Echocardiography View of the Left Atrium Obtained on Postoperative Day 3 The false lumen (asterisk) appears enlarged compared with intraoperative imaging and with the minimal residual true left atrial lumen.

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  Figure 3. Cardiac Computed Tomography With Multiplanar and 3-Dimensional Reconstructions (A) Multiplanar reconstruction image showing the entry tear immediately below the sewing ring of the mitral prosthesis. A serpiginous tunnel (solid arrow) connecting the left ventricle to the false lumen and the measurement of the “landing zone.” (B) Volume-rendered reconstruction highlighting the extent of the atrial wall dissection (solid arrow) and the spatial relationship between surrounding structures, such as the right coronary artery (dotted arrow).

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  Figure 4. Fluoroscopic Images Obtained During the Procedure (A) Angiography of the false lumen with clear detection of the tunnel (solid arrow). (B) Muscular ventricular septal defect occluder positioned across the rupture (dotted arrow) with no interference with the mitral valve prosthesis or significant residual shunt.

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  Figure 5. Postprocedural Transesophageal Echocardiography (A) Color Doppler imaging showing adequate exclusion of the false lumen with no significant residual flow. (B) 3-Dimensional transesophageal echocardiography with a muscular ventricular septal defect occluder (solid arrow) and Figulla II ASD Occluder (dotted arrow) in the final position.