Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis

Abstract

Introduction Chronic constrictive pericarditis (CCP) is common in developing countries, tuberculosis being the most common cause. Dyspnea and congestive symptoms are the most common nonspecific presenting symptoms that require further evaluation for clinching the diagnosis. Coexistent right atrial (RA) thrombus and CCP are rare occurrences. Preoperative detection of RA thrombus is very important to avoid the risk of pulmonary thromboembolism during pericardiectomy or cannulation for establishing cardiopulmonary bypass (CPB). Perioperative echocardiography may play a crucial role in this setting. We report a case of CCP in which preoperative transesophageal echocardiography (TEE) detected RA thrombus that led to change in surgical plan and provided continuous monitoring during surgery. Case Report A 14-year-old male presented with a history of abdominal distension and pedal edema for 5 months. Physical examination revealed raised jugular venous pulse with normal heart sounds and no murmurs. Transthoracic echocardiography (TTE) revealed constrictive physiology and thickened pericardium. After induction of anesthesia, TEE revealed an irregular hyperechoic mass (50 × 36 × 30 mm) in the RA free wall that was not detected on preoperative TTE and computerized tomography (CT). Thickened pericardium all around mandated limited pericardiectomy under TEE guidance to allow bicaval cannulation for establishing CPB. This was followed by surgical removal of the thrombus and remaining pericardiectomy using CPB. His postoperative period was uneventful and the patient was discharged home on postoperative day 7. Conclusion The TEE may be instrumental in diagnosis of coexistent RA thrombus in the case of CCP resulting in major change in surgical plan and providing perioperative monitoring to avert significant morbidity and mortality. How to cite this article Ganesan R, Kumar B, Munirathinam GK, Bhat I, Mahajan S. Modification in Surgical Plan following Intraoperative Detection of Co-existent Right Atrial Thrombus by Transesophageal Echocardiography in Chronic Constrictive Pericarditis. J Perioper Echocardiogr 2017;5(1):34-37.

Perioperative Point of Care Cardiac Ultrasound for Anesthetists

“…The training of cardiac anesthesia residents in perioperative point-of-care cardiac ultrasound has led to changes in preoperative diagnosis and surgical management, leading to better patient outcomes. [11][12][13][14] This has also created a better environment for "learning while doing" for these residents. Extending this learning to perioperative caregiver caring for noncardiac surgical patients has also led to better patient outcomes.…”