PMC9842880_01
Two-dimensional transthoracic echocardiography: short axis (A) and apical four-chamber Doppler color (B) showing a severely calcified degenerative aortic stenosis and a moderate paravalvular mitral regurgitation, respectively.
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It was described as a degenerative aortic valve with severe calcification and stenosis, moderate paravalvular mitral regurgitation with slightly raised gradients of the mitral bioprosthetic, severe pulmonary hypertension, and dysfunctional right ventricle (Figure 1).
Cardiac computed tomography with intravascular contrast in the left chambers. The axial plane shows a continuity solution in the septal portion of the mitral ring, dissecting the atrial septum through a flap formation that protrudes in the right atria (A). Sagittal plane, the left atrial wall dissection exhibits a 42 x 34 mm maximum diameter (B). Three-dimensional reconstruction of the left chambers and aortic arch, showing left atrial wall dissection as an interatrial septum protrusion through the region where the right atria should appear, not present due to lack of contrast (C).
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TAVI included a cardiac contrast computed tomography for characterization of aortic annulus, coronary ostium location, and patency of the arterial femoral iliac branches. The practiced study resulted in an accidental detection of LAWD, described as a continuity solution of the septal portion of the mitral ring that extends to form an interatrial septum dissection flap (Figure 2).
Transesophageal echocardiography: left atrial wall dissection (LAWD) is observed basally as a cavity placed in the interatrial septum, with thin walls and a small size in diastole (A). With Doppler color assessment, LAWD receives blood from the left ventricle, showing systolic expansion; in addition, a paravalvular leak originates in the septal portion of the mitral ring (B and C). In a superior esophageal plane, at 40 , LAWD is observed posteriorly to the aortic valve, and it affects the basal and medial portions of the interatrial septum, protruding through the right atria (D).
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These findings were diagnostic for LAWD (TEE, Figure 3).