SURGERY AND HISTOPATHOLOGY
Based on all above findings and symptomatic status of our patient, it was unanimously decided by our multidisciplinary team to operate on this LA mass. Cardiac surgery was performed with median sternotomy and vertical pericardiotomy. Cardiopulmonary bypass established via ascending aorta and bicaval cannulation with myocardial protection delivered by antegrade cardioplegia. After opening the right atrium and exposing LA via fossa ovalis, a large LA mass extending from pulmonary veins superiorly and mitral annulus inferiorly with attachments to IAS and almost all of the posterior wall of LA was seen. After opening the mass, it looked like organised pockets of fresh clots. The mass occupying the posterior wall separated endocardium and epicardium. All the clots were evacuated followed by marsupialisation of LA cavity. The posterior wall and IAS were repaired with bovine pericardial patch. Histopathological examination of mass confirmed organised thrombus with fibrin (Figure 6). Biopsy of the LA septal tissue confirmed focal necrosis of the endocardium with thrombosis. No findings related to malignancy, hydatidosis, myxoma, endocarditis and amyloidosis was observed. The post-operative course was uneventful and patient was discharged on sixth day post-surgery. Pre-discharge echo showed no residual hematoma with patched LA wall on septal and posterior aspect.