PP-062 [AJC » Cardiac imaging - Echocardiography] Left Atrial Wall Dissection After Mitral Valve Replacement and Its Treatment

A 72 year old man was admitted for cardiac surgery. His coronary angiography showed significant stenosis (three vessel disease involvement) with recommendation of coronary artery bypass graft (CABG). Echocardiography showed mild enlarged left ventricular dimension with left ventricular ejection fraction about 40% and moderate to severe mitral regurgitation and significantly thick and calcified aortic valve with moderate aortic stenosis and aortic regurgitation. CABG, MVR and AVR was performed and the Intraoperative transesophageal echo showed mild paravalvular leak of bioprosthetic mitral valve and good function of bioprosthetic AV and patient was transferred to the ICU. During the stay in ICU bedside transthoracic echo showed moderate paravalvular leakage of bioprosthetic MV with linear echo free space in left atrial (LA) free wall with suspected to LA wall dissection and it was confirmed by transesophageal echo which showed high velocity flow of this paravalvular leakage toward the LA and making this echo free space more pulsatile. Because of this flow toward the dissected wall of LA and fear of cardiac ruputure patient was transferred to operation room and the paravalvular flow which was from AV groove toward the LA was closed and finally the TEE showed significant decrease in the size of dissected LA with mild low velocity flow toward it.