Inverted left atrial appendage: a cause of left ventricular inflow obstruction

When a new left atrial mass is discovered by means of echocardiography, the differential diagnosis is usually between thrombus, vegetation, and tumor. In the past decade, however, the physicians were able to document another cause. Our aim is to introduce a case of postoperative inverted left atrial appendage which caused left ventricular inflow obstruction requiring reoperation. We report a 4- year old boy who had inverted left atrial appendage after atrial septal defect repair. He showed signs and symptoms of pulmonary edema postoperatively. We assessed him by echocardiography and discovered a mass in his left atrium necessitating re-operation. The surgeon found and restored inverted left atrial appendage intra-operatively. Because inverted left atrial appendage can cause severe and occasionally life threatening complications, we believe intraoperative transesophageal echocardiography is highly essential to diagnose this pathology and to avoid restorative reoperation