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Intussusception of Left Atrial Appendage Through the Mitral Valve

Department of Cardiovascular Surgery Centre Hospitalier Universitaire Vaudois rue de Bugnon 46 1011 Lausanne, Switzerland

In Volume 7 issue Number 2 of the Asian Cardiovascular & Thoracic Annals, Dhaded and colleagues¹ reported the case of a 4-month-old child who died shortly after repair of a ventricular septal defect. Autopsy showed in-tussusception of the left atrial appendage, projecting into the mitral valve orifice, as the cause of death. The authors did not provide us with enough details of the clinical picture between the end of repair and death, in particular, we are not aware if an intraoperative or postoperative echocardiographic investigation had been performed. Therefore, it is possible that the complication had not been ruled out in time.

Intussusception of the left atrial appendage can complicate surgery for both congenital and acquired heart diseases.² Regarding the cause of intussusception of the left atrial appendage, Dhaded and colleagues¹ pointed out in their discussion that this can occur during inversion of the left auricular appendage in deairing maneuvers or because of left ventricular vent suction. Once a diagnosis of in-tussusception of the left atrial appendage is established during the postoperative period, either by echocardio-graphy (surface or transesophageal) or by magnetic resonance imaging, the limited number of reported cases does not allow for inferences on the relative risks of reoperation versus conservative treatment. Their case suggests a major caution, in spite of a previous report in favor of conservative treatment.³

The potential consequences of this complication could be prevented intraoperatively by careful inspection of the left auricular appendage at the end of cardiopulmonary bypass or by intraoperative echocardiography, either surface or transesophageal. The authors must be commended because of the courage of their report. This potential complication needs to be publicized to make all cardiac surgeons aware that intraoperative recognition (with or without intraoperative echocardiography) can allow immediate successful treatment.

References

1. Dhaded SB, Pathare HP, Ghotkar MS, Khandeparkar J, Magotra RA, Deshpande J, et al. Intussusception of left atrial appendage through the mitral valve. Asian CardiovascThorac Ann 1999;7:142–3.

2. Corno AF. Inverted left auricular appendage. J Thorac Cardiovasc Surg 1998;115:1223–4.[Free Full Text]

3. Allen BS, Ilbawi M, Hartz RS, Kumar S, Theole D. Inverted left atrial appendage: an unrecognized cause of left atrial mass. J Thorac Cardiovasc Surg 1997;114:278–80.[Free Full Text]

This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Antonio F Corno Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Corno, A. F Search for Related Content PubMed Articles by Corno, A. F