{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:14:29Z","timestamp":1760746469775,"version":"build-2065373602"},"reference-count":11,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Left atrial dissection is a rare surgical complication (occurring in 0.16% of cases), which results in the formation of a large cavity between the endocardium and the epicardium. Case Presentation: We report a case of a 78-year-old man who underwent combined aortic and mitral valve replacement. Extensive debridement of the calcified mitral annulus most probably precipitated the formation of a dissection flap detected by transesophageal echocardiography after protamine administration. Profound hypotension and hemodynamic instability were treated with inotropic and vasopressor support and fluid administration without any further surgical intervention. Conclusions: The patient recovered uneventfully under conservative management, highlighting the importance of perioperative echocardiography for prompt diagnosis and tailored intervention.<\/jats:p>","DOI":"10.3390\/reports8040205","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T07:33:50Z","timestamp":1760686430000},"page":"205","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Dissection After Mitral and Aortic Valve Replacement: The Importance of Early Diagnosis of a Rare Entity"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4810-3829","authenticated-orcid":false,"given":"Despoina","family":"Sarridou","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, AHEPA University Hospital of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7804-8352","authenticated-orcid":false,"given":"Sophia Anastasia","family":"Mouratoglou","sequence":"additional","affiliation":[{"name":"3rd Department of Cardiology of Aristotle University of Thessaloniki, Hippocrates General Hospital of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7963-9462","authenticated-orcid":false,"given":"Rafail","family":"Ioannidis","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, General Hospital of Drama, 66100 Drama, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0028-3779","authenticated-orcid":false,"given":"Aikaterini","family":"Amaniti","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, AHEPA University Hospital of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giakoumis","family":"Mitos","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, AHEPA University Hospital of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleni","family":"Argiriadou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, AHEPA University Hospital of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/icvts\/ivu317","article-title":"Left atrial dissection: An almost unknown entity","volume":"20","author":"Fukuhara","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"297","DOI":"10.4103\/aca.ACA_118_17","article-title":"A case of left atrial dissection after mitral valve replacement","volume":"21","author":"Arora","year":"2018","journal-title":"Ann. Card. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1053\/j.jvca.2020.06.064","article-title":"Left atrial dissection and rupture following excision of left atrial myxoma: Role of transesophageal echocardiography","volume":"34","author":"Niyogi","year":"2020","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.athoracsur.2012.12.041","article-title":"Left atrial dissection: Etiology and treatment","volume":"95","author":"Fukuhara","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s13019-020-01112-3","article-title":"Rapidly vanishing left atrial dissection following mitral valve replacement: A case report","volume":"15","author":"Morishita","year":"2020","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/S0003-4975(02)04301-1","article-title":"Left atrial dissection after double valve replacement","volume":"75","author":"Ninomiya","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1111\/echo.14434","article-title":"Left atrial dissection: A rare entity","volume":"36","author":"Suraci","year":"2019","journal-title":"Echocardiography"},{"key":"ref_8","first-page":"1753944720935466","article-title":"Vasoplegia after cardiopulmonary bypass: A narrative review of pathophysiology and emerging targeted therapies","volume":"14","author":"Barnes","year":"2020","journal-title":"Ther. Adv. Cardiovasc. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1213\/01.ANE.0000139357.87358.94","article-title":"Protamine after heparin produces hypotension resulting from decreased sympathetic outflow secondary to increased nitric oxide in the central nervous system","volume":"100","author":"Hamada","year":"2005","journal-title":"Anesth. Analg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/1089253210376673","article-title":"Intraoperative hemodynamic instability during and after separation from cardiopulmonary bypass","volume":"14","author":"Denault","year":"2010","journal-title":"Semin. Cardiothorac. Vasc. Anesth."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1053\/j.jvca.2018.09.016","article-title":"Acute right ventricular failure in cardiac surgery during cardiopulmonary bypass separation: A retrospective case series of 12 years\u2019 experience with intratracheal milrinone administration","volume":"33","author":"Gebhard","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/205\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T08:17:42Z","timestamp":1760689062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":11,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040205"],"URL":"https:\/\/doi.org\/10.3390\/reports8040205","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}