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Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication?

Abstract

OBJECTIVES

Left atrial dissection (LatD) is a rare and heterogeneous condition affecting many cardiovascular areas. The present article, by the means of personal case report illustration and systemic review of different clinical management, is aimed to give to clinicians further knowledge on this controversial topic.

BACKGROUND

LatD is an exceedingly rare but potentially fatal complication of cardiac surgery or catheter-based interventional procedures. Most of the cases are iatrogenic and its incidence is expected to grow due to an increase in the number of percutaneous coronary intervention and structural heart disease procedures. The management of this complication is controversial, and it may depend on related etiologies.

METHODS

We have reported our single-case experience and review of the scientific literature, focusing on the decision-making process and the strategical approach by multimodality imaging techniques.

RESULTS

Our case of LatD with initial hemodynamic instability was surgically treated. Conservative approach is often employed in literature despite the fact that conservative versus surgical approach is debatable, depending on clinical presentation, hemodynamic stability, multimodal imaging findings, and personal experience of the center.

CONCLUSIONS

According to systematic literature review, a watchful-waiting strategy supported by multimodality imaging could be a safe and effective management in stable LatD.

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  • Authors+Show Affiliations

    ,

    Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy.

    ,

    Department of Cardiothoracic Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.

    ,

    Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy.

    ,

    Department of Cardiac Surgery and Heart Transplantation, De Gasperis Center, Niguarda Hospital, Milan, Italy.

    ,

    Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy.

    Cardiac Cath Laboratory, Humanitas Gavazzeni Hospital, Bergamo, Italy. Department of Systemic Medicine, Division of Cardiology, University of Rome Tor Vergata, Rome, Italy.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31141311

    Citation

    Cereda, Alberto Francesco, et al. "Case Report and Systematic Review of Iatrogenic Left Atrial Dissection in Different Cardiovascular Specialties: a Common Treatment for an Uncommon Complication?" Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, 2019.
    Cereda AF, De Luca F, Lanzone AM, et al. Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication? Catheter Cardiovasc Interv. 2019.
    Cereda, A. F., De Luca, F., Lanzone, A. M., Cottini, M., Pastori, L., & Sangiorgi, G. (2019). Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication? Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions, doi:10.1002/ccd.28356.
    Cereda AF, et al. Case Report and Systematic Review of Iatrogenic Left Atrial Dissection in Different Cardiovascular Specialties: a Common Treatment for an Uncommon Complication. Catheter Cardiovasc Interv. 2019 May 29; PubMed PMID: 31141311.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Case report and systematic review of iatrogenic left atrial dissection in different cardiovascular specialties: A common treatment for an uncommon complication? AU - Cereda,Alberto Francesco, AU - De Luca,Fabio, AU - Lanzone,Alberto M, AU - Cottini,Marzia, AU - Pastori,Luca, AU - Sangiorgi,Giuseppe, Y1 - 2019/05/29/ PY - 2019/03/17/received PY - 2019/04/17/revised PY - 2019/05/16/accepted PY - 2019/5/30/entrez KW - atrial imaging KW - iatrogenic complication KW - left atrial dissection KW - left atrial hematoma JF - Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions JO - Catheter Cardiovasc Interv N2 - OBJECTIVES: Left atrial dissection (LatD) is a rare and heterogeneous condition affecting many cardiovascular areas. The present article, by the means of personal case report illustration and systemic review of different clinical management, is aimed to give to clinicians further knowledge on this controversial topic. BACKGROUND: LatD is an exceedingly rare but potentially fatal complication of cardiac surgery or catheter-based interventional procedures. Most of the cases are iatrogenic and its incidence is expected to grow due to an increase in the number of percutaneous coronary intervention and structural heart disease procedures. The management of this complication is controversial, and it may depend on related etiologies. METHODS: We have reported our single-case experience and review of the scientific literature, focusing on the decision-making process and the strategical approach by multimodality imaging techniques. RESULTS: Our case of LatD with initial hemodynamic instability was surgically treated. Conservative approach is often employed in literature despite the fact that conservative versus surgical approach is debatable, depending on clinical presentation, hemodynamic stability, multimodal imaging findings, and personal experience of the center. CONCLUSIONS: According to systematic literature review, a watchful-waiting strategy supported by multimodality imaging could be a safe and effective management in stable LatD. SN - 1522-726X UR - https://www.unboundmedicine.com/medline/citation/31141311/Case_report_and_systematic_review_of_iatrogenic_left_atrial_dissection_in_different_cardiovascular_specialties:_A_common_treatment_for_an_uncommon_complication L2 - https://doi.org/10.1002/ccd.28356 DB - PRIME DP - Unbound Medicine ER -