Name, academic degree, and ORCID ID of author:
- Ali Baran Budak: MD, Assoc. Prof. Cardiovascular Surgeon,
0000-0002-9772-1765
- Halil Huzmeli: MD, Cardiovascular Surgeon, 0000-0002-2085-0382
- Enis Oguz: MD, Prof. Cardiologist, 0000-0002-5979-4445
- Ahmet Ozkara: MD, Prof. Cardiovascular Surgeon. 0000-0002-3757-3545
Conflict of Interest: Dr. Ali Baran Budak , Dr. Halil Huzmeli,
Dr. Enis Oguz and Dr. Ahmet Ozkara have no conflicts of interest.
Acknowledgement: This study did not receive any specific grant
from funding agencies in the public, commercial, or not-for-profit
sectors
Key-words: robot-assisted, left atrial mass, leukemia,
minimally invasive
ABSTRACT
Spontaneous Intramural left atrial hematoma that mimics a primary or
metastatic cardiac tumor is a very rare entity. We report a case of a
60-year-old man suffering from chronic myeloid leukemia, who was
admitted for prolonged chest pain and fatigue. Transthoracic
echocardiography revealed a left atrial mass in close proximity to the
posterior mitral annulus and failed to provide an ethiological
diagnosis. Surgical management was utilized to outrule the atrial
neoplasm and to prevent emboli, obstruction and mitral valve
insufficiency. This is the first case in the literature in which
robot-assisted minimally invasive surgery was adopted to manage such a
rare entity.
Key words: intramural left atrial hematoma, robot-assisted, minimally
invasive
INTRODUCTION
Left atrial intramural hematoma (LAIH) is a rare occurrence that has
been documented as associated with percutaneous coronary interventions
or surgical cardiac procedures, radiofrequency ablations, mitral annular
calcification3, myocardial infarction, blunt chest
trauma and dissecting aneurysm of the aorta1-5. The
robot-assisted minimally invasive approach, increasingly popular in
recent years, was used to surgically manage this case of spontaneous
LAIH mimicking a left atrial mass; until now, the literature contains no
reports of this approach to managing this rare entity.
CASE REPORT
A 60-year-old man presented to our hospital with prolonged atypical
chest pain, progressive shortness of breath and fatigue. At the time of
admission, his haemodynamic status was stable and electrocardiogram,
chest X-ray findings were normal. Subsequent laboratory tests revealed a
white blood cell count of 66,54 K/uL (normal value: 4,23-9,07).
Transthoracic echocardiography (TTE) revealed a left atrial mass (4,7 x
2,5 cm) attached to the posterior wall and inter-atrial septum in close
proximity to the posterior mitral annulus, and minimal pericardial
effusion (Figure 1).
Figure 1: Modified parasternal long-axis transthoracic echocardiogram
(preoperative). *Left atrial mass (4,7 x 2,5 cm) attached to the
posterior wall and inter-atrial septum. LA, Left Atrium; Ao, Aorta; LV,
Left Ventricle.