Bishnu Panigrahi

An unexpected structure in the right atrium after patch closure of an atrial septal defect.

A fi A 50-YEAR-OLD WOMAN was admitted to the hospital with chest pain and dyspnea on mild exertion for 7 months. Clinical examination revealed a systolic murmur in the left second intercostal space with no other clinical abnormality. Preoperative transthoracic echocardiography revealed atrial septal defects (ASDs) of both the ostium primum and the ostium secondum type, which were confirmed by transesophageal echocardiography (TEE) (Fig 1 and Video 1 [supplementary videos are available online]). Surgical correction of the defects was planned. After anesthetic induction and intubation, intraoperative TEE confirmed the preoperative findings and also found a small cleft in the anterior mitral leaflet. Single patch closure for both the defects was performed. The patient was weaned from cardiopulmonary bypass (CPB) without significant inotropic support. Post-CPB TEE revealed adequate patch closure of the defects without any residual