Left atrial dissection: an almost unknown entity

Left atrial dissection is an exceedingly rare but potentially fatal complication of cardiac surgery. It is most commonly associated with mitral valve surgery, including both replacement and repair, with a reported incidence rate of 0.16%. However, other cardiac surgical or catheterbased interventional procedures are also known as potential predisposing factors. The time of presentation from the cause of dissection varies extremely, ranging from immediate occurrence up to 20 years later. The dissection forms a large cavity between the endocardium and epicardium of the left atrium, causing obliteration of the left atrial cavity and resultant haemodynamic compromise, which almost always requires immediate surgical intervention. In contrast, left atrial dissection without haemodynamic instability can often be managed non-operatively with satisfactory outcomes. This article reviews this rare but relevant clinical entity to further elucidate the incidence, pathogenesis, clinical course, management and outcome of left atrial dissection.