A Case Report of Left Atrial Appendage Invagination in Post Operation Setting

Abstract

Introduction: The left atrial appendage (LAA) lies within the confines of the pericardium in close relation to the free wall of the left ventricle. The LAA is long and thin with a narrow base. The LAA is best evaluated by transesophageal echocardiography. Surgeons may ligate the LAA during mitral valve (MV) replacement to remove a potential source of embolism. Unfortunately, a high rate of unsuccessful LAA occlusion has been reported, regardless of the technique employed. Case Presentation: A 57-year-old woman underwent cardiac surgery (mitral valve, aortic valve and tricuspid valve replacement and LAA closure). In post pump intra-operational transesophagial echocardiography (TEE) we detected a hypoechogenic mass in left atrium. It has no interference with mechanical MV prosthesis and pulmonary veins. Because of its new presentation after cardiac surgery, we suggested that it might be invaginated LAA. After confirmation, this complication was treated by pulling it out. Conclusions: The inversion of LAA is a rare complication. This diagnosis should be considered when a pedunculated mass is encountered in these setting. To prevent this complication, we suggest the use of intraoperative TEE to avoid unnecessary work up and fatal complications.