Right
atriotomy incision was done parallel to the atrial groove.
Intraoperative Finding After
Atriotomy Showing Multiple Calcified Thrombi Adherent to The Trabecuiated Portion of Right Atrium
The voltage map demonstrated a line of scar at the lateral right atrium, representing the
atriotomy scar from the operation to remove the LA myxoma.
Upon commencing extracorporeal circulation, a longitudinal left
atriotomy was made through the right atrium-atrial septum.
After left
atriotomy, mitral valve exploration revealed severe pannus tissue and thrombi on both sides of mechanical valve's hinge area and sewing cuff (Figure 1).
Through a median sternotomy, on moderately hypothermic cardiopulmonary bypass with aortic and bicaval cannulation, the left atrium was entered through a right
atriotomy and transseptal incision.
Right
atriotomy revealed opening of fistula into right ventricle under the tricuspid valve.
The inferior border of the
atriotomy was sewn around the anterior part of the tricuspid annulus, and the superior border was brought over the lateral wall of the right atrium as a flap and sewn near the interatrial groove.
The patient had right
atriotomy and pulmonary endarterectomy with extraction of a large amount of thrombotic material that obstructed the pulmonary arteries (Figures 5 and 6).
After initiation of cardiopulmonary bypass, the mass was approached through right
atriotomy. A large firm, smooth, and lobulated mass was identified at the right atrium impinging the tricuspid valve and prolapsing into the right ventricle (Figure 1).