DISCUSSION
Since spontaneous LAIH is a very rare entity, its true incidence is
unknown. Even the best imaging techniques sometimes fail to
differentiate the diagnosis, and as in the present case, histological
confirmation via surgical exploration is required.
Generally the literature concerning LA hematoma includes only case
reports. LA hematoma can occur very rarely spontaneously, as in our
case, as well as secondary to complications in cardiac surgery or
percutaneous interventions and ablation of atrial
tachyarrhythmias2,6-8. It has also been associated
with amyloidosis, blunt chest trauma, mitral annular calcification,
mitral annular abscess, dissecting aortic
aneurysm2,6-8. LAIH generally originates from
posterior LA wall due to the lower quantitiy of fibrous tissue and
because the posterior leaflet of the mitral valve is more prone to
calcification2. Altough the position of the LAIH in
our case is consistent with the literature, no patient or procedural
factors was found. TTE remain as the first-line study in differential
diagnosis9.
Due to lack of previous experience and established protocols management
of this entity is challenging in terms of timing and approach. In this
case, presumptive diagnosis was left atrial neoplasm. As TTE indicated
blocked blood flow to the left ventricle and potential hemodynamic
instability, surgical intervention was chosen as the best management
option.
The most common intracardiac tumor to have been successfully excised
using robotic technology has been the left atrial
myxoma10. Robotic system affords excellent exposure,
magnification and flexibility. The operative technique mimics that of a
mitral valve procedure. Improved surgical exposure, reduced
postoperative pain, shorter hospitalization, lower mortaliy and
perioperative complication rates have been reported as major advantages
of robotic approach11. Our case is the first case of
spontaneous LAIH that was managed via robot-assisted minimally invasive
surgical intervention.
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