Large Thrombus Formation from Right Atrial Incision Site after Closure of Atrial Septal Defect
A 24-year-old female patient with a history of primary repair for ASD performed 8 years ago admitted to our clinic for her annual checkups. In her previous primary repair surgery, the defect was closed directly with an atriotomy incision followed by 5/0 polypropylene and 4/0 polypropylene sutures. The patient had attended her ensuing controls every three months for a period of one year, and no pathological findings were identified during this period. There was no history of any drugs being used recently. Physical examination was normal, and routine hematological and biochemical laboratory analysis were within normal levels. Electrocardiogram revealed normal sinus rhythm and right bundle branch block. Transthoracic echocardiography (TTE) revealed normal left ventricular systolic functions, mildly dilated right chambers, minimal mitral regurgitation, mild tricuspid regurgitation, systolic pulmonary artery pressure of 30 mm Hg, and an irregular-shaped mass in the right atrium. On her transesophageal echocardiography (TEE) examination, a 3.7×3.5 cm sized giant pedunculated mobile mass was observed being attached to the septum in the right atrium (). After the procedure, the patient was hospitalized. Chest computed tomography (CT) showed no evidence of pulmonary embolism, and ventilation/perfusion scans indicated no problems. Protein C, protein S, and antithrombin III levels were within the normal range. Venous bilateral Doppler of lower extremity and abdominal ultrasonography results were normal. The patient was scheduled for excision of the mass. Surgery was performed via a median sternotomy by utilizing the cardiopulmonary bypass. Venous drainage was via the superior vena cava and the right femoral vein. The right atrium was being opened, and a large mass filling the entire atrium and obstructing the tricuspid valve was observed. The mass was intimately attached to the free atrial wall, it was irregularly-shaped, and 2.2×4.1 cm in dimension. It had a tanned, gelatinous appearance, and showed multifocal areas of calcification. The entire free wall of the right atrium mass was resected. The patient was weaned off with cardiopulmonary bypass without any difficulty. The mass consistent with thrombus formation originating from the suture line was excised (). Histopathological evaluation was consistent with the organized thrombus.