Name, academic degree, and ORCID ID of author:
  1. Ali Baran Budak: MD, Assoc. Prof. Cardiovascular Surgeon, 0000-0002-9772-1765
  2. Halil Huzmeli: MD, Cardiovascular Surgeon, 0000-0002-2085-0382
  3. Enis Oguz: MD, Prof. Cardiologist, 0000-0002-5979-4445
  4. 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.