Left Atrial Dissection During Minimally Invasive Mitral Valve Surgery

Figures

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  Figure 1. Two-dimensional TEE, midesophageal long-axis view of the MV, without (left) and with (right) color flow Doppler, demonstrates a flail P2 pathology (yellow arrow) and anteriorly directed MR (white arrow). AV, Aortic valve; LA, left atrium; LV, left ventricle.

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  Figure 2. Three-dimensional TEE, zoomed, high-definition live-rendering view from the perspective of the right atrium, demonstrates the en face intra-atrial septum with an ASD (yellow arrow) measuring 1.1 cm2 by planimetry. There is an artifact (yellow asterisk), which was due to spontaneous echocardiographic contrast (SEC). SVC, Superior vena cava.

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  Figure 3. Two-dimensional TEE, midesophageal long-axis (132°) view with continuous-wave Doppler spectral profile through the MV, demonstrates an averaged mean pressure gradient (meanPG) of 2.0 mm Hg following successful MV repair. HR, Heart rate; maxPG, maximal pressure gradient; Vmax, maximal velocity; Vmean, mean velocity; VTI, velocity-time integral.

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  Figure 4. Two-dimensional TEE, midesophageal four-chamber (0°) view, demonstrates a well-circumscribed mass descending into the left atrium (yellow asterisk) and the repaired MV (arrow) obtained before transferring patient to the intensive care unit. LV, Left ventricle; RA, right atrium; RV, right ventricle.

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  Figure 5. Two-dimensional TEE, midesophageal orthogonal imaging (77° and 167°) demonstrates the large hematoma (asterisk) within the false lumen of the traumatic LA dissection and the repaired MV (arrows). AV, Aortic valve; LAA, LA appendage; LV, left ventricle.