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Heart, Lung and Circulation (2014) xx, 1–2 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.02.001
Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect Hao-rui Sun, MDa, Hong Tang, MDb, Hai-bo Song, MDa* a
Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China Department of Echocardiography, West China Hospital, Sichuan University, Chengdu, Sichuan, China
b
Received 17 December 2013; accepted 5 February 2014; online published-ahead-of-print xxx
Keywords
Thrombosis Heart atria Atrial septal defect Cardiac surgical procedures Anticoagulation
An 18 year-old woman who underwent secundum atrial septal defect (ASD) closure with a dacron patch 10 months prior returned for follow-up examinations. She received no anticoagulation therapy and remained asymptomatic after surgery. The patient was in normal sinus rhythm and there was no abnormality in physical examination or coagulation testing. Transthoracic echocardiograms (TTE) showed a globular, moderate echoic, homogenous mass (2 cm 2 cm) attached to the anterolateral wall of the right atrium by a narrow stalk, moving back and forth during the cardiac cycle without changing shape or protruding into the right ventricle (Fig. 1A, Video 1). Delayed gadolinium-enhanced
cardiac magnetic resonance imaging demonstrated the hypointense mass to be a thrombus (Fig. 1B). Considering the risk of embolisation, the patient underwent open heart surgery. Intraoperative transoesophageal echocardiogram (TEE) confirmed the mass was at the entrance of the superior vena cava and interatrial septal patch was intact (Fig. 1C, Video 2). A grey-red, hard mass attached to the right atrial incision was removed (Fig. 2A). Microscopical examination of the mass revealed a mixed thrombus (Fig. 2B). She was started on aspirin at discharge. At sixmonth follow-up, TTE showed no recurrent atrial thrombosis.
Figure 1 (A) TTE (apical four-chamber view on the left and parasternal long-axis view of right ventricular inflow tract on the right) showing a globular, moderate echoic, homogenous mass attached to the anterolateral wall of the right atrium by a narrow stalk (arrows). (B) Delayed gadolinium-enhanced cardiac magnetic resonance image (four-chamber view) showing a hypointense mass in the right atrium (arrow). (C) TEE (midoesophageal bicaval view) revealing the right atrial mass at the entrance of the superior vena cava with an intact interatrial septal patch (arrow). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.
*Corresponding author at: Department of Anaesthesiology, West China Hospital, Sichuan University, NO. 37 Guo Xue Ave., Chengdu 610041, Sichuan, China. Tel.: +86 18980601682; fax: +86 028 85423593, Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Sun H-r, et al. Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.02.001
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H.-r. Sun et al.
Figure 2 (A) Photograph of the excised mass showing a grey-red ball mass with a fine pedicle. (B) Haematoxylin and eosin stain at 200 magnification demonstrating a mixed thrombus.
Artificial patch may serve as the nidus for thrombosis after patch-based repair of ASD [1]. However, formation of right atrial thrombus attached to the atrial incision is exceedingly rare. This case suggests that prophylactic anticoagulation therapy after patch closure of ASD may deserve attention and consideration.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j. hlc.2014.02.001.
Reference
Acknowledgments The authors declare that there is no financial support with the manuscript, and no conflicts of interest.
[1] Kuwahara E, Otsuji Y, Matsuoka T, Minagoe S, Sakata R, Tei C. Transesophageal echocardiographic diagnosis of left atrial mass as thrombus by demonstrating its attachment to the patch closing atrial septal defect: a case report. J Am Soc Echocardiogr official publication of the American Society of Echocardiography 2002;15:473–4.
Please cite this article in press as: Sun H-r, et al. Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.02.001
IMAGE
Heart, Lung and Circulation (2014) xx, 1–2 1443-9506/04/$36.00 http://dx.doi.org/10.1016/j.hlc.2014.02.001
Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect Hao-rui Sun, MDa, Hong Tang, MDb, Hai-bo Song, MDa* a
Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China Department of Echocardiography, West China Hospital, Sichuan University, Chengdu, Sichuan, China
b
Received 17 December 2013; accepted 5 February 2014; online published-ahead-of-print xxx
Keywords
Thrombosis Heart atria Atrial septal defect Cardiac surgical procedures Anticoagulation
An 18 year-old woman who underwent secundum atrial septal defect (ASD) closure with a dacron patch 10 months prior returned for follow-up examinations. She received no anticoagulation therapy and remained asymptomatic after surgery. The patient was in normal sinus rhythm and there was no abnormality in physical examination or coagulation testing. Transthoracic echocardiograms (TTE) showed a globular, moderate echoic, homogenous mass (2 cm 2 cm) attached to the anterolateral wall of the right atrium by a narrow stalk, moving back and forth during the cardiac cycle without changing shape or protruding into the right ventricle (Fig. 1A, Video 1). Delayed gadolinium-enhanced
cardiac magnetic resonance imaging demonstrated the hypointense mass to be a thrombus (Fig. 1B). Considering the risk of embolisation, the patient underwent open heart surgery. Intraoperative transoesophageal echocardiogram (TEE) confirmed the mass was at the entrance of the superior vena cava and interatrial septal patch was intact (Fig. 1C, Video 2). A grey-red, hard mass attached to the right atrial incision was removed (Fig. 2A). Microscopical examination of the mass revealed a mixed thrombus (Fig. 2B). She was started on aspirin at discharge. At sixmonth follow-up, TTE showed no recurrent atrial thrombosis.
Figure 1 (A) TTE (apical four-chamber view on the left and parasternal long-axis view of right ventricular inflow tract on the right) showing a globular, moderate echoic, homogenous mass attached to the anterolateral wall of the right atrium by a narrow stalk (arrows). (B) Delayed gadolinium-enhanced cardiac magnetic resonance image (four-chamber view) showing a hypointense mass in the right atrium (arrow). (C) TEE (midoesophageal bicaval view) revealing the right atrial mass at the entrance of the superior vena cava with an intact interatrial septal patch (arrow). LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.
*Corresponding author at: Department of Anaesthesiology, West China Hospital, Sichuan University, NO. 37 Guo Xue Ave., Chengdu 610041, Sichuan, China. Tel.: +86 18980601682; fax: +86 028 85423593, Email: [email protected] © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.
Please cite this article in press as: Sun H-r, et al. Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.02.001
HLC 1523 No. of Pages 2
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H.-r. Sun et al.
Figure 2 (A) Photograph of the excised mass showing a grey-red ball mass with a fine pedicle. (B) Haematoxylin and eosin stain at 200 magnification demonstrating a mixed thrombus.
Artificial patch may serve as the nidus for thrombosis after patch-based repair of ASD [1]. However, formation of right atrial thrombus attached to the atrial incision is exceedingly rare. This case suggests that prophylactic anticoagulation therapy after patch closure of ASD may deserve attention and consideration.
Appendix A. Supplementary data Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/j. hlc.2014.02.001.
Reference
Acknowledgments The authors declare that there is no financial support with the manuscript, and no conflicts of interest.
[1] Kuwahara E, Otsuji Y, Matsuoka T, Minagoe S, Sakata R, Tei C. Transesophageal echocardiographic diagnosis of left atrial mass as thrombus by demonstrating its attachment to the patch closing atrial septal defect: a case report. J Am Soc Echocardiogr official publication of the American Society of Echocardiography 2002;15:473–4.
Please cite this article in press as: Sun H-r, et al. Ball Thrombus in the Right Atrium after Patch Closure of Atrial Septal Defect. Heart, Lung and Circulation (2014), http://dx.doi.org/10.1016/j.hlc.2014.02.001
