Left Atrial Dissection After Mitral and Aortic Valve Replacement: The Importance of Early Diagnosis of a Rare Entity.

Background and Clinical Significance: Left atrial dissection is a rare surgical complication (occurring in 0.16% of cases), which results in the formation of a large cavity between the endocardium and the epicardium. Case Presentation: We report a case of a 78-year-old man who underwent combined aortic and mitral valve replacement. Extensive debridement of the calcified mitral annulus most probably precipitated the formation of a dissection flap detected by transesophageal echocardiography after protamine administration. Profound hypotension and hemodynamic instability were treated with inotropic and vasopressor support and fluid administration without any further surgical intervention.

Conclusions

The patient recovered uneventfully under conservative management, highlighting the importance of perioperative echocardiography for prompt diagnosis and tailored intervention.