Anesth Pain Med.  2016 Oct;11(4):389-392. 10.17085/apm.2016.11.4.389.

Accidental left atrial appendage thrombus detected by intraoperative transesophageal echocardiography during coronary artery bypass graft: A case report

• Jun JH
• Lee MH
• Choi EM
• Kim EM
• Lee HK
• Baek SH
• Chung MH

• KMID: 2358337
• DOI: http://doi.org/10.17085/apm.2016.11.4.389

Abstract

A 77-year-old woman was scheduled for a coronary artery bypass graft. Her preoperative transthoracic echocardiographic (TTE) examination revealed an enlarged left atrium with reduced systolic dysfunction (ejection fraction: 38%), moderate global hypokinesia of the left ventricle, and moderate mitral and tricuspid regurgitation. No thrombus was visualized on the preoperative TTE. However, the intraoperative transesophageal echocardiography performed before the cardiopulmonary bypass revealed a thrombus of approximately 1.3 × 1.8 cm in the left atrial appendage (LAA). The LAA thrombus was removed, an internal suture was placed on the LAA before the coronary artery bypass grafting, and the main operation was performed successfully. The patient was transferred to the intensive care unit to receive postoperative care. She was extubated 4 h after the surgery and was transferred to the general ward on postoperative day 3 without any neurological sequelae.

Keyword

Atrial appendage; Thrombosis; Transesophageal echocardiography

MeSH Terms

Aged
Atrial Appendage*
Cardiopulmonary Bypass
Coronary Artery Bypass*
Coronary Vessels*
Echocardiography
Echocardiography, Transesophageal*
Female
Heart Atria
Heart Ventricles
Humans
Hypokinesia
Intensive Care Units
Patients' Rooms
Postoperative Care
Sutures
Thrombosis*
Transplants
Tricuspid Valve Insufficiency

Figure

• 

  Fig. 1 Transesophageal echocardiography image obtained before CPB showing small immobile thrombus (white arrow) of 1.3 × 1.8 cm in the LAA. CPB: cardiopulmonary bypass, LAA: left atrial appendage.

• 

  Fig. 2 Transesophageal echocardiography image obtained before CPB showing dislodged thrombus (white arrow) after cardiac manipulation. CPB: cardiopulmonary bypass.

• 

  Fig. 3 Transesophageal echocardiography image obtained after CPB showing no thrombus in the LA and ligated LAA. CPB: cardiopulmonary bypass, LA: left atrium, LAA: left atrial appendage.

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