Dissection of the left atrial wall is a rare condition that may be a challenge to diagnose clinically.
Left atrial dissection is defined as
(1) a separation in the left atrial wall caused by hemorrhage
(2) creation of a new space from the mitral valve annulus to the atrial wall and/or intra-atrial septum, with or without a direct communication to the left atrial chamber
If large the dissection may fill most of the atrial chamber and interfere with filling of the left ventricle.
Risk factors:
(1) mitral valve surgery
(2) catheter-based intervention with tear of the endocardium, including PCI
(3) rarely other types of cardiac surgery (aortic valve replacement, CABG, left ventricular aneurysmectomy, cardiac mass excision)
(4) severe calcification of the mitral annulus
(5) cardiac trauma
The onset after the inciting procedure may be immediate, acute, delayed or late.
The patient may be clinically stable or unstable at onset. If symptomatic the patient develops low volume heart failure.
The diagnosis is most often based on imaging studies, including transesophageal echocardiography.
