Large Thrombus Formation from Right Atrial Incision Site after Closure of Atrial Septal Defect

Atrial septal defect (ASD) is the common congenital anomaly which requires surgical interventions. Right atrial thrombus formations after primary suture repairs of the ASD and evidences of thromboembolic complications are extremely rare. Specifically, the cases of thromboembolic complications have high mortality and morbidity risks. Two cases of giant intra-atrial thrombus formation detected in the late stage after primary repairs of ASDs are being discussed.

Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old

BACKGROUND: There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. MATERIALS AND METHODS: We reviewed the clinical course of 57 patients (mean age: 63.54+/-5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8+/-4.5 years. RESULTS: One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. CONCLUSION: Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.

Intracardiac Varix in the Right Atrium: 2 case reports / 대한흉부외과학회지

Intracardiac varix is an endocardial, unilocular, blood-filled cyst that's lined by endothelial cells and it is filled with organizing thrombi. It has been reported that intracardiac varix is an extremely rare entity. We report here on two cases of intracardiac varix in the right atrium and these cases had been preoperatively misdiagnosed as myxoma.

Resection of a Congenital Left Atrial Appendage Aneurysm without Extracorporeal Circulation / 대한흉부외과학회지

A left atrial appendage aneurysm is a very rare medical condition which can develop by an inflammatory reaction or a degenerative change. If there is no accompanying anomaly, a left atrial appendage is considered a congenital disease. The majority of left atrial appendage aneurysms are detected incidentally because they usually do not cause any symptoms. Surgery is indicated, even for asymptomatic patients, because of the risk of life-threatening complications, such as atrial fibrillation, supraventricular tachycardia, systemic embolization, and cardiac arrest. Left atrial appendage aneurysms are usually treated by a median sternotomy with extracorporeal circulation, especially if the aneurysm has a broad base or contains a thrombus, but can treated by thoracotomy without extracorporeal circulation. We report a case of a successfully treated left atrial appendage aneurysm that was misdiagnosed as a partial pericardial defect without extracorporeal circulation in a 13-year old child.

Change of the Left Atrial Dimension and Transport Function after the Cox-Maze Procedure for Treating Atrial Fibrillation Associated with Mitral Valve Disease: the Short-term and Mid-Term Results / 대한흉부외과학회지

BACKGROUND: Although the high efficiency of conversion into sinus rhythm has been demonstrated after performing the Cox-Maze procedure in patients with atrial fibrillation associated with mitral valve disease, the changes in the mechanical function and size of the left atrium have not been determined. The aim of this study was to evaluate the effect of the Maze procedure on the left atrial size and contractile transport function. MATERIAL AND METHOD: From July 1997 to July 2008, 647 consecutive patients were operated on for chronic atrial fibrillation associated with mitral valve disease. Among these, 211 patients that (1) were able to be followed up for 2 years after surgery, (2) had sustained normal sinus rhythm, regardless of whether they were taking anti-arrhythmic medications and (3) did not have valvular regurgitation greater than grade III or they did not have moderate grade valvular stenosis were selected for evaluation. The left atrial size and contractile transport function were assessed by transthoracic echocardiography at the postoperative base line (1 year) and at regular follow-up periods (2 years, 3 years, 4 years and 6 year). RESULT: The left atrial dimension was increased and the contractile transport function was decreased during the follow-up period. The longer the follow-up period, the greater was the statistical significance of the left atrial size increase and contractile transport function decrease. CONCLUSION: In patients who sustain normal sinus rhythm conversion after a Maze III procedure with a mitral valve operation, there is a gradual increase of the left atrial dimensions and a decrease of contractile transport function during the follow-up period. Therefore, scrupulous follow-up is needed for these patients.

Congenital Intrapericardial Left Atrial Appendage Aneurysm Presenting with an Embolic Stroke: A case report / 대한흉부외과학회지

Congenital intrapericardial left atrial appendage aneurysms (LAAA) are very rare. Most cases are asymptomatic and this malady is generally incidentally diagnosed in older patients. LAAAs are usually accompanied with supraventricular arrhythmias and life-threatening systemic embolism. Complete surgical correction is recommended immediately after the diagnosis to prevent significant complications, and even for the asymptomatic patients. We report here on the case of a 45-year-old man who presented with cerebral embolism due to LAAA. The patient was successfully treated with a resection of the aneurysm.

Right Atrial Thrombus Mimicking Right Atrial Myxoma / 대한흉부외과학회지

A right atrial thrombus in structurally normal heart is very rare. A 66-year-old woman was admitted with chest discomfort and dyspnea. She was diagnosed of right atrial myxoma on echocardiography and chest computed tomography. We performed an excision of the mass attached to atrial septum, which was found to be an organized mural thrombus by pathologic examination. We report this rare case with a review of literature.

Effect of Left Atrial Volume Reduction with Maze Operation on Sinus Conversion and Recovery of Left Atrial Transport Function / 대한흉부외과학회지

BACKGROUND: The Maze procedure considered the most effective method of treatment for atrial fibrillation. However, the sinus conversion rates decreased due to several factors, especially enlarged left atrium. The purpose of this study was to investigate the effects of Maze procedure with left atrial volume reduction plasty on rheumatic mitral valve disease. MATERIAL AND METHOD: From December of 2001 to July of 2004, 45 patients received mitral valve and Maze operation. The patients were placed in either group 1 or group 2, based on the left atrial volume reduction plasty. The presence and onset of sinus rhythm and the incidence of trans mitral A waves were monitored during the postoperative 7 days and throughout the follow up period of 3 and 6 months. Mean follow up periods were 15.8 10.1 months in group 1 and 6.1+/-2.7 months in group 2. RESULT: The sinus onset were 9.88+/-12.2 days in group 1, and 1+/-3.6 days in group 2 (p<0.01). The sinus conversion rates in the group 1 and 2 were 65%, 75% (p=0.07) in the postoperative 7 days, 70.5%, 100% (p<0.01) at postoperative 3 months, and 93%, 100% (p<0.01) at postoperative 6 months, respectively. The wave detection rates in the postoperative 7 days were 31.2% and 63.6%, and continued to improve over time to 83.3% and 100% by 6months, respectively. CONCLUSION: The results suggest that Maze procedure with left atrial volume reduction plasty is effective for inducing sinus rhythm and for restoring left atrial contractile function after concomitant rheumatic mitral valve surgery. However further follow up of this patients for long time is necessary.

Surgical Removal of Large Thrombus at the Suture Site of the Right Atriotomy after Atrial Septal Defect Closure Associated with Pulmonary Embolism: 1 case / 대한흉부외과학회지

Report of right atrial thrombus complicating pulmonary embolism after cardiac surgery is rare. A 54-year-old woman operated on the atrial septal defect 10 months ago was admitted for left pleuritic pain and dyspnea. Multiple segmental perfusion defects were detected in lung perfusion scan. Transesophageal echocardiography showed a large mobile right atrial mass attached to the free wall of the right atrium with a stalk. Despite the intravenous heparinization for 13 days, follow-up echocardiography revealed the right atrial mass had not diminished in size. The mass which was confirmed as an organizing thrombus was excised under cardiopulmonary bypass. The patient recovered uneventfully and was discharged on warfarin therapy.

Morphologic Difference of the Atrial Chambers and Determination of the Atrial Situs in the Normal and Congenitally Malformed Heart

BACKGROUND: Identification of atrial situs is the initial step in any segmental analysis and classification of congenital heart malformations. To elucidate the differences for both atria of the normal and congenitally malformed heart, we performed morphological studies on the human heart with or without abnormal laterality syndrome. METHODS: Five normally formed human hearts, five hearts with right isomerism and five hearts with left isomerism were used in this study. The postero-superior walls of the atrial chambers were examined. RESULTS: Although the division line of the ventral and dorsal compartments was not as conspicuous as was seen in the right atrium of rat embryo previously studied, this division line existed as a well-developed terminal crest and vestigial structure of the antero-lateral extension of the terminal crest. These structures were noted in the right atrial chambers of normal human hearts and in the bilateral atrial chambers of right isomerism. However, they were totally absent in the bilateral atrial chambers in hearts with left isomerism. CONCLUSIONS: Our study showed that the right atrial chamber in the normally developed human heart has vestigial components of division between the ventral and dorsal compartment, and hearts with right isomerism and left isomerism have differential development of the ventral and the dorsal compartment.

A case of myxoma attached to both interatrial septum and anterior mital leaflet / 대한내과학회지

Myxoma is the most common primary cardiac tumor. It usually develops on the interatrial septum, and occurs in the left atrium in more than 75% of cases. Myxoma in the ventricle is much less common and accunts for only 5% of cases. A myxoma arising from mitral valve is exceedingly rare and is normally located on the atrial side of valve, with an eqivalent distribution between the anterior and posterior leaflets. We report a case of myxoma that arose from both the interatrial septum and anterior mital leaflet, which has not been previously reported in the literature.

Intravenous leiomyomatosis with intracardiac extension: intracardiac leiomyomatosis-case report and literature review / 대한내과학회지

Intravenous leiomyomatosis is a rare benign vascular tumor defined as the extension into venous channels of a histologically benign smooth muscle tumor arising either from a uterus or from the walls of uterine vessels, and about 10% spread to the heart. The treatment of choice is complete resection of the tumor. Hormonal therapy should be considered in cases of unresectable residual tumor. A 46-year-old woman was admitted for abdominal discomfort and pain. She was found to have intravenous leiomyomatosis of the uterus with extension into inferior vena cava and right atrium. The patient underwent surgery employing simultaneous sternotomy and laparotomy. Radical excision was achieved using cardiopulmonary bypass. We herein describe a patient in whom complete removal of intravenous leiomyomatosis with cardiac extension was successfully performed.

A Case of Intravenous Leiomyomatosis Extending into the Right Atrium

Intravenous leiomyomatosis is a rare entity of benign smooth muscle invading into the lumen of veins. We describe a case of intracardiac leiomyomatosis originating from the right gonadal vein, growing in the inferior vena cava, and extending into the right atrium. A 54 years old woman presented with chest discomfort and syncope four years after the removal of an uterine leiomyoma. The tumor was successfully removed in a two-staged operation using total circulatory arrest with a cardiopulmonary bypass, which proved to be a histologically benign leiomyoma. Although these tumors are histologically benign, they sometimes extend into the cardiac cavity and can cause sudden death due to their incarceration into the atrioventircular orifice. We report this rare case with a review of the literature.

The Relationship of Left Atrial Volume and Left Ventricular Diastolic Dysfunction

BACKGROUND AND OBJECTIVES: Mitral flow Doppler has been used to evaluate left ventricle (LV) diastolic function by mitral E/A flow ratio, isovolumic relaxation time (IVRT) and deceleration time (DT) of E wave. Such variables can be affected by various factors. The increase in left atrium (LA) afterload and preload is accompanied by increased LA size. So, we investigated the relationship of LA volume and LV diastolic dysfunction. MATERIALS AND METHOD: From January 2000 to July 2000, 39 patients were included in this study. They were classified into normal (M:F=5:6, mean age 54.0+/-11.4 years), impaired relaxation (M:F=5:4, mean age 70.0+/-5.5 years), pseudonormal (M:F=5:3, mean age 68.3+/-13.2 years) and restrictive physiology (M:F=10:1, mean age 65.5+/-12.7 years) according to mitral inflow variables. The LA volume of each groups was measured by Simpson method, M-mode method and arealength method. RESULTS: 1) The LA volumes measured by Simpson method, M-mode method and area-length method were correlated (p<0.001, r=0.925 in Simpson compared with arealength method). 2) The LA volume by Simpson method were found 54.4+/-16.4 cm3 in normal, 57.3+/-9.2 cm3 in impaired relaxation, 81.4+/-28.8 cm3 in pseudonormal and 119.8+/-64.5 cm3 in restrictive physiology. 3) The LA volume were significantly increased in pseudonormal group compared with normal (p<0.05). CONCLUSION: The LA volume is a useful and easy diagnostic stool for evaluating of LV diastolic function.

A Case of Synchronous Primary Right Atrial Myxoma and Occult Hepatocellular Carcinoma

The incidence of cardiac metastasis of hepatocellular carcinoma (HCC) is about 1-4% and especially metastasis to right atrium (RA) is very rare, with an incidence of only 0.7-3% in a postmortem series. But, most RA tumors associated with HCC are intracardiac metastasis and the occurrence of synchronous primary RA myxoma and HCC is extremely rare. We report one case that a cardiac mass was primary RA myxoma initially misdiagnosed as occult HCC with intracardiac metastasis.

Surgical Repair of the Congenital Aneurysm of the Rght Atrium / 대한흉부외과학회지

The four most common types of congenital malformations involving the right atrium(RA) and the coronary sinus(CS) are congenital enlargement of the RA, single RA diverticulum, multiple diverticula of the RA, and aneurysm of the RA or CS. A previously healthy 6year-old child was presented with signs of upper respiratory tract infection. Chest X-ray and echocardiogram revealed a severely isolated right atrial enlargement. The abnormally dilated right atrim was widely resected under cardiopulmonary bypass. Pathology revealed multifocal myocardial loss associated with mild fibrotic changes of the endocardium and epicardium. Our experience on this rare congenital disease is presented along with a review of the literature.

Surgical Repair of the Congenital Aneurysm of the Rght Atrium / 대한흉부외과학회지

The four most common types of congenital malformations involving the right atrium(RA) and the coronary sinus(CS) are congenital enlargement of the RA, single RA diverticulum, multiple diverticula of the RA, and aneurysm of the RA or CS. A previously healthy 6year-old child was presented with signs of upper respiratory tract infection. Chest X-ray and echocardiogram revealed a severely isolated right atrial enlargement. The abnormally dilated right atrim was widely resected under cardiopulmonary bypass. Pathology revealed multifocal myocardial loss associated with mild fibrotic changes of the endocardium and epicardium. Our experience on this rare congenital disease is presented along with a review of the literature.

Angiosarcoma in Right Atrium / 대한흉부외과학회지

Primary cardiac tumors are rare, and primary malignant cardiac tumors are even rarer. Of these, angiosarcoma was uncommon. Surgical resection of the tumor was very difficult because symptoms were nonspecific and did not become present until the tumor had advanced. A 15-year-old male patient was diagnosed with primary cardiac angiosarcoma by microscopic examination under surgery and underwent resection of the tumor, which compressed and obstructed the right atrium. He was discharged from the hospital after 15 days without any problems.

Characteristics of hypoxia-induced ANP Secretion in Perfused Beating Atria / 대한흉부외과학회지

BACKGROUND: Cardiac atrium is an endocrine gland secreting a family of natriuretic peptides. The secretion of atrial natriuretic peptide(ANP) had been shown to be controlled by variable factors. The change in atrial dynamics have been considered as one of the most prominent stimuli for the stimulation of ANP secretion. Hypoxic stress has been shown to increase cardiac ANP secretion. However, the mechanism by which hypoxia increases ANP secretion cardiac ANP secretions. However, the mechanism by which hypoxia increases ANP secretion has not to be defined. Therefore, the purpose of the present study was tow-fold: to develop a protocol to defined the effect of hypoxia on ANP secretion in perfused beating rabbit atria and to clarify the mechanism responsible for the accentuation by hypoxia of ANP secretion. MATERIAL AND METHOD: Experiments have been done in perfused beating rabbit atria. ANP was measured by radioimmunoassay. RESULT: Hypoxic stimulus with nitrogen decreased atrial stroke volume. The decrease in atrial stroke volume recovered basal level during the period of recovery with oxygen. ANP secretion and the concentration of perfusate ANP in terms of extracellular fluid(ECF) translocation which reflects the rate of myocytic release of ANP were increased by hypoxia and returned to basal levels during the recovery. Changes in ECF translocation paralleled by hypoxia and returned to basal levels during the recovery. Changes in ECF translocation paralleled to that of atrial stroke volume. At the start of recovery in atrial storke volume, ECF tranalocation incrased for several minutes. The above responses were stable and reproducible. Glibenclamide treatment prevented the recovery in atrial stroke volume. Increments by hypoxia of ANP secretion and ANP concentration were suppressed by glibenclamide. CONCLUSIONS: These results indicate that hypoxia incrased atrial myocytic ANP release and that the mechanism responsible for the accentuation is partially related to the change in K+ATP channel activity.

Congenital Left Atrial Appendage Aneurysm: A Case Report / 대한흉부외과학회지

Congenital left atrial appendage aneurysm is a very rare congenital cardiac abnormality. That is postulated to arise from a developmental weakness in the atrial wall in utero. Clinically, patients are often asymptomatic and are diagnosed incidentally, but supraventricular arrhythmias and systemic thromboembolism have also been reported in some cases. Surgical resection at the time of diagnosis is recommended because of the propensity for thromboembolic complications. A 13-month-old female, who was suspected preoperatively as having partial absence of pericardium with left atrial herniation through the defect, underwent surgical resection of the left atrial appendage aneurysm. Exposure through a median sternotomy showed an intact pericardium. The postoperative course was uneventful.