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

BACKGROUND

Left atrial dissection (LatD) is a rare and life-threatening complication of mitral valve surgery.

CASE SUMMARY: A 60-year-old woman underwent mitral valve replacement for severe mitral regurgitation. Intraoperative transesophageal echocardiography revealed a LatD caused by a covered atrioventricular (AV) groove rupture, with systolic flow from the left ventricle into an atrial false lumen (FL). Moreover, an interatrial septal fenestration, connected the FL with the right atrium. Despite initial hemodynamic stability, multimodality imaging demonstrated a progressive enlargement of the FL. Given the prohibitive surgical risk, a fully percutaneous transaortic closure of the AV groove rupture was successfully performed using a ventricular septal defect occluder, followed by closure of the interatrial septal fenestration.

DISCUSSION: Heart team decision making and multimodality imaging are fundamental in managing LatD.

TAKE-HOME MESSAGE: Percutaneous transaortic closure may represent a lifesaving alternative to redo surgery in selected cases of AV groove rupture complicated by LatD.