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.