부산대학교 도서관

A 72-year-old woman presented with transient right arm weakness, and a left atrial (LA) mass was diagnosed on echocardiography as a source of embolism. She underwent a successful surgical excision for the LA mass which was confi rmed to be myxoma on histopathologic specimen. One month after discharge, she subsequently developed left arm weakness, and transesophageal echocardiography (TEE) presented a 13 × 7 mm sized mass with irregular lobulated surface on surgical beds. Based on detailed review of the surgical procedure which achieved en-bloc resection including full thickness of interatrial septum with broad base, a probable diagnosis was made to be a thrombus rather than a remnant of the tumor. We started administration of intravenous heparin as a therapeutic trial, and the repeated TEE in a week presented much decreased size of the mass in question (8 × 3 mm). Anticoagulation with warfarin was then continued, and a follow-up TEE at 4-months showed complete resolution of the mass in question, confi rming the diagnosis of a thrombus. Embolic events after surgery of cardiac myxoma have been rarely reported. However, in theory, all endocardial damage, myocardial exposure, suture material, and geometric change after cardiac surgery can provoke thrombogenic milieu. Although a thrombus on surgical beds is uncommon, a possibility should not be neglected because it can potentially cause critical neurologic complications postoperatively. The present case highlights 1) the importance of clinical suspicion for intracardiac thrombi after cardiac surgery; 2) the advantage of serial follow-up of TEE which could discriminate postoperative thrombi from remnants of cardiac tumor, therefore we could avoid unnecessary second-look operation.