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.
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).
All operations were conducted in moderate hypothermia (32[degrees]C); in all patients, a left atriotomy
was made to access the mitral valve; different surgical repairing techniques were employed depending on the primitive mitral lesion but a prosthetic ring was implanted in all patients (Table 2).
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).
Via a right atriotomy
and transseptal approach, the rheumatic stenotic mitral valve leaflets were excised and a 29 mechanical bileaflet ST Jude valve (St.