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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