OA-23: ASYMPTOMATIC GIANT RIGHT ATRIAL THROMBUS AFTER SURGICAL CLOSURE OF AN ATRIAL SEPTAL DEFECT


Günay Ş. , Şenkaya Sığnak I. , Özdemir B. , Çitoğlu G., Güllülü N. S.

International Young Academy of Cardiology Congress, Gazimagusa, Cyprus (Kktc), 18 - 22 September 2019, pp.28

  • Publication Type: Conference Paper / Summary Text
  • City: Gazimagusa
  • Country: Cyprus (Kktc)
  • Page Numbers: pp.28

Abstract

Introduction: Atrial septal defect (ASD) is a tissue defect which allows blood passing between both atria. For the treatment of ASD, percutaneous closure or surgical repair techniques are applied. Right atrial thrombi appearing in the postoperative period is a rare finding Herein, we report a case of large right atrial thrombus developed in the early stage after pericardial patch plasty of secundum type ASD. Case:: A 28-year-old male patient with a pericardial patch repair history of secundum type ASD performed 4 months ago admitted to outpatient cardiology clinic for routine follow-up. He was clinically asymptomatic and physical examination was unremarkeable. Routine hematological and biochemical laboratory analysis were within normal levels. Electrocardiogram revealed normal sinus rhythm. Transthoracic echocardiography (TTE) revealed normal left ventricular systolic functions, minimal tricuspid regurgitation and an irregular-shaped, 32x19 mm sized right atrial mass attached to interatrial septum with a thin pedincule (Figure 1a). The pediculated giant mass was mobile and prolapsing into the tricuspid valve from time to time. There was no right ventricular dilatation and pulmonary artery systolic pressure was normal. The patient did not have any medication and was hospitalized. Protein C, protein S and antithrombin III levels were within the normal ranges. Venous bilateral doppler of lower extremity results were normal. Arterial blood gas analysis was normal. The patient did not accept undergoing a redo surgery and was scheduled for intravenous unfractioned heparin infusion for 48 hours. Dose adjustment was done based on activated clotting time and activated partial thromboplastin time. After heparin infusion was completed, echocardiographic examination still revealed 29x15 mm sized pedunculated mobile mass (Figure 1b). Then, the patient finally accepted surgery. Excision of the mass with redo sternotomy was decided for treatment. During the surgery, exploration of the right atrium revealed a 3x2 cm sized mass attaching to inferior site of interatrial septum with a thin pedincule (Figure 2). It was observed that the pericardial patch was epithelized. Histopathological evaluation was consistent with the organized thrombus. The patient had uneventful postoperative courses and was discharged with warfarin (international normalized ratio: 2-3) on postoperative seventh day. Conclusion: The importance of routine echocardiographic follow-up after surgery should be kept in mind. Further studies on long-term antiplatelet and anticoagulant therapy after surgical ASD closure are necessary. Keywords: atrial septal defect, surgery, thrombus