Incidental Finding of a Right Atrial Appendage Thrombus During Cardiac Surgery

      RIGHT ATRIAL APPENDAGE (RAA) thrombi are encountered much less frequently than their left-sided counterparts. This difference is explained partly by dissimilarities in appendage anatomy and function. Atrial fibrillation (AF), right ventricular failure, and pulmonary hypertension are associated with RAA clots. Right atrial appendage thrombi remain a potential risk for serious embolic events and need to be addressed accordingly. The left atrial appendage (LAA) is studied routinely for the presence of thrombi in the setting of AF. The same cannot be said of the RAA. The authors describe a rare case of RAA thrombus found on intraoperative transesophageal echocardiography (TEE) in a patient with paroxysmal AF undergoing coronary artery bypass surgery. These findings illustrate the importance of TEE examination of the right atrial appendage for patients undergoing cardiac surgery who have AF and right-sided heart failure.

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